Dermatology Online Journal

Acquired Blaschko Dermatitis-seventh case
Petar Bojanic and Ivan Simovic¹
Dermatology Online Journal 9 (1): 12

1.Department of Dermatology, Health Center Krusevac, Krusevac Yugoslavia

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Abstract

The February edition of Dermatology Online Journal 2002;7(1):8, contained an article entitled Acquired Blaschko Dermatitis.[1] A 64 year old patient with erythematous patches and papules in a reticulate pattern on the left upper extremity and on the left side of the chest, abdomen, back and buttock was described. Three months later, in the Department of Dermatology, Health Center Krusevac, we examined a 65 year old woman with similar lesions, distributed in a linear pattern on her right lower limb, following the lines of Blaschko.

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Case presentation:

Figure 1	Figure 2
Figues 1 and 2: Pretreatment images of the thighs

Figure 3	Figure 4
Figures 3 and 4: Pretreatment of the popliteal fossae

A 64 year old woman presented to the Department of Dermatology, Health Center, Krusevac, with a two month history of an asymptomatic eruption that was limited to the right lower extremity and both popliteal fossae. There was no history of atopic dermatitis, psoriasis, or previous dermatitis. Past medical history was unremarkable. She lived in a highly stressful environment with her husband, a chronic alcoholic. A biopsy and a potassium hydroxide fungal examination were performed, and topical glucocorticoids were prescribed. The eruption remained unchanged after one month of topically applied fluocinolone acetonide 0.025% ointment.

Erythematous patches and papules were noted in a linear arrangement on her right lower extremity and both popliteal fossae, following the lines of Blaschko. She noted that lesions worsened in times of stress (provoked by her hubsband' s behavior while drunk).

A potassium hydroxide preparation was negative for hyphae.

Figure 5	Figure 6
Figures 5 and 6: Histology demonstrating perivascular lymphocytic infiltrate.

Examination of the histopathology showed hyperkeratosis with sparse parakeratosis and a flattened dermo-epidermal junction. In the upper dermis there was a chronic lymphocytic infiltration, particularly localized around blood vessels, without a remarkable presence of eosinophils. There was no spongiosis.

Figure 7	Figure 8
Figures 7 and 8: Seven days after treatment.

After the unsuccessful treatment with a topical corticosteroid, we introduced systemic therapy with oral prednisolone. The initial dose was 1 mg/kg/day (60mg per day), with rapid tapering by 5mg each day. Significant improvement was noted after seven days. Occasional relapse has been noted in times of stress.

Discussion

Dr. Hale stated that, "Approximately five cases of acquired Blaschko dermatitis have been reported. Neither the etiology nor the pathogenesis of this condition is completely understood. Several of the previously described cases failed to respond to treatment with topical glucocorticoids but responded to systemic glucocorticoid therapy. The condition seems to relapse, especially at times of stress."[1]

Herein we have presented a patient with clinical and histological changes similar to those described above. After systemic corticosteroid therapy, our patient responded excellently, and her skin changes disappeared, but have recurred periodically during times when she is experiencing increased stress.

References

1. Acquired Blaschko Dermatitis. Elizabeth K. Hale, M.D.Dermatology Online Journal 2002;7(1):8

2. Grosshans E, Marot L. [Blaschkitis in adults] Ann Dermatol Venereol 1990;117(1):9-15.

3. Jackson R. The lines of Blaschko: a review and reconsideration: Observations of the cause of certain unusual linear conditions of the skin. Br J Dermatol 1976;95(4):349-60.

4. Bolognia JL, Orlow SJ, Glick SA. Lines of Blaschko. J Am Acad Dermatol 1994;31(2 Pt 1):157-90; quiz 190-2.

5. Megahed M, Reinauer S, Scharffetter-Kochanek K, Milde P, Holzle E, Goerz G, Ruzicka T. Acquired relapsing self-healing Blaschko dermatitis. J Am Acad Dermatol 1994;31(5 Pt 2):849-52.

6. Lee HJ, Kang WH, Hann SK. Acquired Blaschko dermatitis: acquired relapsing self-healing Blaschko dermatitis. J Dermatol 1996;23(9):639-42.

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