A dermatologist's guide

Asymmetric skin lesions in children - Lichen striatus and APEC

Dear Parents!

In this article, I want to introduce you to two "ASYMATRIC ACCIDENTS" that suddenly appear on your children's skin and that often cause you concern, prompting a visit to a pediatric dermatology clinic.

These are Lichen striatus and APEC. They resemble a rash, erythema, papular petechiae appearing suddenly and persisting for a long time on a child's skin. In the article, I will try to introduce you to these rare but anxiety-inducing ailments.  

Red welts in children

Lichen striatus is a rare skin disorder, actually of unknown etiology, occurring in children. In the clinical picture, it presents in the form of clustered papules, gently exfoliating, which run serpiginously according to Blaschko's lines. These are lines of cell development in the skin that are not visible under normal conditions. They become visible when certain skin diseases manifest according to these "V", "S" shaped patterns. The lesions are usually located in the extremities.

Lichen striatus is a self-limiting condition, resolving spontaneously within 1-2 years.

A rash on one side of the body

APEC (asymmetric periflexual exanthem of childhood), or asymmetric unilateral periflexual pediatric rash, on the lateral side of the chest. It is a self-limiting papulopustular erythematous rash that is often preceded by mild upper respiratory tract infections or diarrhea. Fever accompanies the disease in 40% of cases. The skin lesions appear on one side of the body, on the trunk and near the larger flexural areas, i.e. the armpits and groin, and then spread adhesively to adjacent parts of the trunk and upper and lower extremities. After 2-4 weeks, the rash also appears on the other part of the body, but remains prominent only on one.

The rash lasts a long time, sometimes up to 6-8 weeks. Illnesses usually occur in late winter or early spring. Children aged 2 to 3 years are mainly affected, but there can also be cases in 8-month-olds or 10-year-olds. Treatment is unnecessary, sometimes symptomatic for pruritus.

Both diseases, in fact, do not require treatment, only patience is needed . However, they are sometimes confused with allergic contact dermatitis or hemiplegia, so they should always be consulted with a pediatric dermatology specialist.

dr. med. Joanna Nowak-Guzowska