Chinnasamy, M (2009) Clinicopathological correlation of Linear Dermatoses in Childhood. Masters thesis, Stanley Medical College, Chennai.
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Abstract
INTRODUCTION : Skin is a miracle garment. It is soft, pliable, strong, water proof and self-repairing. It is the largest organ of the integumentary system, made up of multiple layers of epithelial tissues, and guards the underlying muscles, bones, ligaments and internal organs. It covers between 1.5 and 2m2, comprising about one sixth of total body weight, also it is the only organ which is visible and is in direct contact with the environment. In the examination of the skin, the morphology of individual lesions, their overall pattern and spatial relationship to each other, and their body site distribution are helpful and provide an easily recognizable clue to a rapid visual diagnosis. Indeed, clinical diagnosis is more precise than laboratory tests in many disorders. Skin lesions present with innumerable patterns like Discoid, Petaloid, Arcuate, Annular, Polycyclic, Livedo, Reticulate, Target, Stellate, Digitate, Linear, Serpiginous, Whorled, etc. Among these patterns, Linearity is a stellar pattern which attracts the attention of patients and clinicians alike. A single lesion may assume a linear shape or a number of lesions may be arranged in a linear pattern. The mechanisms or anatomical factors dictating the Linearity are of the following groups. 1. Linear configurations determined by the course of blood vessels, lymphatics or nerve trunks. 2. Linear lesions of developmental origin. 3. Linear lesions following Dermatomal pattern. 4. Linear lesions caused by External factors like Plants, Allergens, Chemicals, thermal and Physical factors (includes Koebner’s phenomenon). 5. Linear configurations due to other determinants. Most of the Linear lesions follow the Blaschko’s lines. Children with linear lesions attending the Dermatology Out Patient Department at Govt. Stanley Hospital comprise this study group. AIMS OF STUDY : 1. To study the Incidence of Childhood Linear Dermatoses at the Skin Out Patient Department, Government Stanley Hospital, Stanley Medical College, Chennai, during the period September 2006 to August 2008. 2. To study the age and sex distribution. 3. To study the various sites of distribution. 4. To study the symptomatology and predisposing factors. 5. To look for other associated conditions. 6. To study the histopathological pattern. MATERIALS AND METHODS : This study includes 60 cases of linear dermatoses in childhood. They were assessed clinically and histologically and routine investigations like blood, urine and motion examinations. X-ray tests were done wherever necessary. Detailed and complete history in all the 60 cases studied was taken. Their address, occupation and socioeconomic status were noted. Special reference regarding the marital status of parents was kept in mind to rule out a genetic basis. Sibling history was taken in all cases to rule out an infectious origin if other siblings were affected by same dermatosis. Great care was taken to find out associated skin disorders like Alopecia Areata or nail changes. Special importance was given to rule out Koebnerization. Other special findings like Auspitz sign for psoriasis and Wickham’s striae for Lichen Planus were noted. For the cases of Epidermal Nevus Syndrome, opinions of specialty departments like Neurology, Ophthalmology, Oto-Rhino-Laryngology and Dentistry were sought. All cases of lichen planus were screened for HBsAg. Complete physical examination was done for each child with special reference to lymphadenopathy, mucosal changes, Hair changes and Nail changes. Palms and Soles were also examined. Skin biopsy was done for amenable children from the advancing edge of lesions. Biopsy slides were studied with H & E staining. CONCLUSION : The following conclusions were drawn from this study. 1. The Incidence of childhood Linear Dermatoses in the skin Out Patient Department, Govt. Stanley Hospital, Stanley Medical College, Chennai during the period of Sep.2006 to August 2008, 0.66%. 2. Among the childhood Linear Dermatoses, Lichen striatus was found to be more common (41.7%). 3. The other Dermatoses following Blaschko’s lines, in the descending order of frequency seen in this study were Linear Lichen Planus (25%), Linear Verrucous Epidermal Nevus (15%), Linear Morphoea (8.3%), Linear Vitiligo (6.7%), Linear Psoriasis (3.3%). 4. Incidence wise both lichen striatus and linear morphoea was found to be more in the female children, where as linear lichen planus and linear epidermal nevus showed slight male preponderance. The incidence of linear psoriasis and segmental vitiligo were found to be equal in both the sexes. 5. The importance of histopathological correlation is very obvious. Cases which were clinically diagnosed as Lichen Striatus showed histopathological features of Psoriasis and Linear Epidermal Verrucous Nevus, ultimately changing the management in any given condition. So, it is imperative to do histopathological study in all linear lesions as the line of management varies in each condition. 6. Majority of children showed unilateral distribution in a linear pattern, more often on the extremities. 7. Very few associations were noted such as cases of Lichen Planus which were associated with Insect bite allergy and Tinea versicolor and Lichen striatus with Xerosis, Tinea Versicolor. 8. The lesions were more of a cosmetic concern in most of the children in this study.
| Item Type: | Thesis (Masters) |
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| Uncontrolled Keywords: | Linear Dermatoses in Childhood ; Clinicopathological correlation. |
| Subjects: | MEDICAL > Dermatology Venereology and Leprosy |
| Depositing User: | Subramani R |
| Date Deposited: | 02 Mar 2018 02:22 |
| Last Modified: | 02 Mar 2018 02:22 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/5959 |
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