For more than 70 years, Bacillus Calmette-Guerin (BCG) vaccines have been
administered safely to billions of individuals throughout the world. Local
adverse reactions following BCG vaccination usually occur at a rate of 0.1
to 0.5 per 1000 vaccinations, and serious, disseminated complications
occur at a rate of less than 1 in a million vaccinations [1]. Physicians
should be aware of the various adverse effects of this commonly used
vaccine for proper management. We herein present an infant who developed
lichen striatus (LS) following BCG vaccination.
A 7-month-old girl was brought with linearly arranged
hypopigmented skin lesions of four month duration along the lateral aspect
of her left upper limb. The lesions typically followed the lines of
Blaschko (Fig. 1). She was asymptomatic and there was
neither any history of pruritis, drug intake nor any infection preceding
the eruption. The birth history was normal. There was history of atopic
dermatitis in the mother. She was given BCG vaccine at two and half months
of age and the skin lesions started two weeks after immunization. The
patients relatives did not give consent for a skin biopsy. A diagnosis of
lichen striatus was made on the basis of her clinical history and physical
examination. The WHO causality assessment criteria for adverse events
following immunization suggests that the adverse event (lichen striatus)
was probably related to BCG vaccination [2]. We treated her with
emollients only, without any other topical therapy. She is well on follow
up after 2 months with the skin lesions still persisting.
|
Fig. 1 Linearly arranged hypopigmented
skin lesions along the lateral aspect of left upper limb typically
following the lines of Blaschko. |
Lichen striatus is a rare, benign, self-limited linear
dermatosis that predominantly affects children between 5 months and 15
years of age [3]. It has been reported to occur after infections and
following immunization with MMR or hepatitis B. These act as potentially
triggering factors with the skin lesions usually appearing over 2 to 3
weeks after the event [3]. The lesions are usually
pink or flesh-coloured, lichenoid papules that are arranged in continuous
or interrupted bands. Rarely, patients can have hypopigmented macules and
papules, as seen in our patient. Such lesions are classified as lichen
striatus albus [4]. Lichen striatus is clinically diagnosed on the basis
of its appearance and characteristic developmental pattern following the
lines of Blaschko, which are thought to correspond to the migration of
embryonic skin cells [3,4]. The etiology of LS is unknown. Atopy may be a
predisposing factor and upto 85% of patients with LS have a positive
history of atopic disorders [3]. The lesions are most commonly located on
a proximal extremity and less commonly on the trunk, head, neck, or
buttock. Lesions are usually asymptomatic with pruritis being a rare
complaint. The mean duration of the disease is 6 to 9 months [3,4]. No
specific treatment is required. Some studies have mentioned the beneficial
role of topical corticosteroids and tacrolimus ointment in the treatment
of lichen striatus with prolonged course or multiple lesions [4,5]. The
caregivers should be reassured about the benign nature of the disease.
References
1. Grange JM. Complications of Bacille Calmette-Guérin
(BCG) vaccination and immunotherapy and their management. Commun Dis
Public Health. 1998;1:84-8.
2. Collet JP, MacDonald N, Cashman N, Pless R.
Monitoring signals for vaccine safety: the assessment of individual
adverse event reports by an expert advisory committee. Advisory Committee
on Causality Assessment. Bull World Health Organ. 2000;78:178-85.
3. Dragos V, Mervic L, Zgavec B.
Lichen striatus in a child after immunization. A case report. Acta
Dermatovenerol Alp Panonica Adriat. 2006;15:178-80.
4. Moore K, Lam JM. The toddler with 1 striped leg: a
linear papular rash. CMAJ. 2009; 28;180:947-8.
5. Vukiĉeviĉ J, Milobratoviĉ D, Vesiĉ S,
Miloseviĉ-Jovĉiĉ N, Ciriĉ D, Medenica L. Unilateral multiple lichen
striatus treated with tacrolimus ointment: a case report. Acta
Dermatovenerol Alp Panonica Adriat. 2009;18:35-8.