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Eruptions similar to those of lichen planus (LP) are associated with systemic diseases or have been induced by many drugs. Linear lesions as a Koebner effect are frequently found in LP but isolated long, narrow, linear lesions, which may extend the whole length of the limb, are rare though rather more common in childhood. Some cases of zonal or zosteriform LP have been described in the literature. We describe a case of LP with a linear distribution following the Blaschko embryologic lines induced by nicergoline in a 65-year-old woman with a 6-month history of a pruritic eruption of erythematoviolaceous papules on the left breast, trunk and upper limb, with histological features of LP. It would be the first case of linear LP associated with drugs. Miguel A. Muñoz, Departamento de Dermatología, Hospital Virgen Macarena, Avda. Dr. Fedriani s/n, E-41075 Sevilla (Spain) Linear and zosteriform variants of lichen planus (LP) are rare forms of LP. To our knowledge these forms of LP have not been associated with drugs. We describe a case of LP with a linear distribution following the Blaschko embryologic lines induced by nicergoline. Case Report We observed a 65-year-old woman with a history of hypertension treated with nicergoline, an αadrenergic blocking agent, for 6 months. She presented a pruritic eruption with a linear distribution 4 months after beginning this treatment. Physical examination revealed an erythematoviolaceous eruption consisting of flat-topped shiny papules along the Blaschko lines affecting the left breast, hemithorax, axillae with an ‘S’ shape and a longitudinal location on the ventral side of the left arm (fig. 1). Routine laboratory examination including blood count and hepatic parameters as well as spinal cervical and dorsal column X-rays were normal. The cutaneous biopsy showed hyperkeratosis with prominent focal hypergranulosis, Civatte bodies and hydropic degeneration of the basal epidermal layer with Max-Joseph spaces. A lichenoid lymphocytic infiltrate with numerous eosinophils in superficial and mid-dermis was present. Treatment with nicergoline was stopped and 2 months later only a residual lesion on the axillae remained which was infiltrated with betametasone (3 mg/ml) and 1 month later had completely disappeared. D ow nl oa de d by : 54 .7 0. 40 .1 1 10 /5 /2 01 7 11 :0 4: 22 P M Lichenoid drug eruption (LDE) may be clinically identical to idiopathic LP and a detailed clinical history is important in order to make the diagnosis [1], Numerous drugs can be inducers of LDE [2] and α-adrenergic KAKGER E-Mail karger¢7⁄8arger.ch Fax+ 41 61 306 12 34 http://www.karger.ch © 1996 S.KargerAG, Basel 1018-8665/96/1931-0066$ 10.00/0 most drug eruptions and may be even longer than 3 years [3, 4J. Histopathological studies have not found any specific features which can differentiate LDE from LP. However, Fig. 1. Lichenoid eruption affecting left breast, hemithorax and arm. blocking agents are also causes of LDE. The latent period between the beginning of a pharmacological treatment and the appearance of the eruption is longer in LDE than in certain findings such as the presence of eo-sinophils and plasma cells in the cellular infiltrate are more characteristic of LDE [2]. Zosteriform LP is a relatively rare variant of LP [5,6] which has not to date been associated with drugs. Lesions of zosteriform LP appear with a metameric pattern in relation with segmental cutaneous nerves. On the other hand, lesions of’blaschkitis’ do not follow any neural, vascular or lymphatic line and appear with the shape of ‘V with open arms’ in the dorsal raquis, in form of a D ow nl oa de d by : 54.70.40.11-10/5/201711:04:22PM horizontal ‘S’ in the anterior trunk, of a spiral in the scalp and in a longitudinal shape in thelimbs. However, some authors describe a certain or probable relationship between linear LP andBlaschko lines [7].Grosshans et al. [8] propose the term blaschkitis for those acquired lesions that follow Blaschkolines and the linear distribution might be explained by cellular mosaicism. During fetal life amutation may have caused a clone of cells with a different histocompati-bility antigen topopulate a specific area of the skin. An immunological tolerance to aberrant cellular clones mayexist but several factors may induce a specific cellular clone to acquire different qualities, as forexample a membrane antigen that would induce the immune response causing the dermatosis [6,9].Freemer et al. [10] described 2 cases of lichenoid chronic graft-vs-host disease occurring in adermatomal distribution and suggested that the dermatomal distribution of their patients’ lesionswere associated with HZV infection.In our patient the lichenoid lesions follow these Blaschko embryonal lines with a typicaldistribution. To our knowledge this is the first case of LDE that follows Blaschko lines and itmust be differentiated from zosteriform LP.ReferencesBork K: Lichenoid eruptions; in Cutaneous Side Effects of Drugs. Philadelphia, Saunders. 1988,pp 170-171.Halevy S, Shai Avi: Lichenoid drug eruption. J Am Acad Dermatol 1993;29:249-255.Powell FC, Rogers RS III, Dickson ER: Primary biliary cirrhosis and lichen planus. J Am AcadDermatol 1983;9:540-545.Seehafer JR, Rogers RS Ill, Fleming CR: Lichen planus-like lesions caused by penicil-lamine inprimary biliary cirrhosis, Arch Dermatol 1981;117:140-142.Arregui MA, Sanz C, Raton JA, et al: Liquen piano zosteriforme: aportación de dos casos. ActasDermosifilogr 1993;84:25-28. Harder NK, Kasha EE: Pruritic zosteriform eruption. Zosteriformlichen planus. Arch Dermatol 1990;126:665-668. Louste, Castel and Juster: Deux cas de lichenplan à disposition zoniforme. Bull Soc Fr Dermatol Syphilol 1927;34:851. Grosshans E, MarotL: Blaschkite de Γadulte. Ann Dermatol Vénéréol 1990;117:9-15.9 Beers B, Kalish RS, Kaye VN, Dahl MV: Unilateral linear lichenoid eruption after bonemarrow transplantation: An unmasking of tolerance to an abnormal keratinocyte clone. J AmAcad Dermatol 1993;28:888-892. 10 Freemer CS, Farmer ER, Corio RL, Altomonte VL,Wagner JE, Vogelsang GB, Santos GW: Lichenoid chronic graft-vs-host disease occurring in adermatomal distribution. Arch Dermatol 1994;130:70-72. Lichenoid Drug Eruption Following the Blaschko LinesDermatology 1996; 193:66-6767 Downloadedby: 54.70.40.11-10/5/201711:04:22PM