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correspondence

Indian Pediatr 2011;48: 163-164

Lichen Striatus Following BCG Vaccination in an Infant


Syed Ahmed Zaki and S Sanjeev

Department of Pediatrics, LTM General Hospital and Medical College, Mumbai 400 022, Maharashtra, India.
Email: [email protected] 
 


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 patient’s 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.
 

 

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