‘Zosteriform’ Lichen planus: Is It Zosteriform?

Lichen planus, linear Blaschko’s lines Zosteriform pattern Köbner phenomenon Rudolf Happle, MD, Department of Dermatology, University of Marburg, Deutschhausstrasse 9, D-35037 Marburg (Germany) I read with interest the article by Fink-Puches et al. [1] on an unusual case of linear lichen planus showing a strikingly unilateral and systematized arrangement. They interpret the ‘zosteriform’ pattern as a cutaneous reaction possibly triggered by some neural factor, and they discuss several hypothetical pathomechanisms such as a Köbner phenomenon after herpes zoster infection, a viscerocutaneous reflex or a radicular irritation caused by a disorder of the vertebral column. However, following Alfred Blaschko’s line of thought we should recognize a clear-cut difference between a zosteriform distribution and the usual arrangement of linear skin lesions [2]. When studying the case reports on linear or zosteriform lichen planus reported in the literature, I have come to the conclusion that in virtually all of these cases the lesions were arranged in a pattern following the lines of Blaschko [3-10]. Forexample, a characteristic S-figure on the antero-lateral aspect of the abdomen has been documented [8-10]. Notwithstanding, some exceptional cases of true zosteriform lichen planus