A Pediatric Hero Among Us
These hypopigmented, mildly pruritic lesions on the right arm of a 7-year-old African American girl appeared several weeks ago. She had no other lesions and was otherwise healthy. The diagnosis on the basis of the clinical presentation was lichen striatus.
This benign, self-limited, unilateral dermatosis of unknown cause usually affects children aged 5 to 10 years.1 Girls are affected 2 to 3 times more frequently than boys. The primary lesion is a flat-topped red to violaceous papule covered with fine scale. However, in African American patients, the lesion may be hypopigmented. Aggregates of these papules form multiple bands of plaques, which may range from a few millimeters to 1 to 2 cm in width. The lesions occur most commonly on one arm or leg but can affect the neck or trunk. The linear distribution may follow the lines of Blaschko and may extend the entire length of an extremity.2
Lichen striatus can be differentiated clinically from lichen nitidus and eczema by its linear configuration. Conditions such as linear lichen planus and linear psoriasis are usually associated with characteristic individual lesions elsewhere on the body. The lesions of linear epidermal nevi are permanent and often become more hyperkeratotic and hyperpigmented than those of lichen striatus.
A lichen striatus eruption typically evolves over a period of days or weeks in an otherwise healthy child, remains unchanged for weeks to months, and eventually resolves without sequelae. However, nail dystrophy may occur when the eruption involves the posterior nail fold and matrix. Symptoms are usually absent. For children who have associated inflammation, a topical corticosteroid may provide symptomatic relief.
Dr Bhagwan Das Bang will be honored at the American Academy of Pediatrics (AAP) 2009 National Conference & Exhibition (NCE) in Washington, DC, on October 20 with the Pediatric Heroes Award. He was 1 of 4 pediatricians selected by the NCE Planning Group Executive Committee to receive the award. Last fall, the AAP was tasked with finding stories of the "every day pediatric heroes among us." The 4 winners were chosen from hundreds of entries and after much deliberation by the committee.
Dr Bang grew up in a small town in India where he watched children suffer because of lack of preventive medicine. This inspired him to pursue a career as a pediatrician. He graduated from Osmania University in 1986 as an Indian Council of Medical Research Scholar. He was chosen as best graduating pediatrician from Niloufer Hospital, Hyderabad—the largest hospital in southern India. Before immigrating to the United States, he practiced in the neonatal ICU at Al Yamamah Hospital in Riyadh, Saudi Arabia, for 5 years. On completion of residency and chief residency at Kansas University Medical Center, Kansas City, he began practicing in rural southern Alabama, where he continues to provide care for underprivileged children as a solo pediatrician. Here he lives with his wife, Kanchan, and 2 children, Sneha and Pavan. In his spare time, he is also a preceptor for medical students on rural rotations and a regular contributor to Consultant for Pediatricians.