Correspondence 363

limited by the Koebner phenomenon. J Am AcadDermatol 1990;22:87-91.

JULIE S. PRENDIVILLE, M.B., MRCPI,FRCPCVancouver, Canada

LINEAR LICHEN FLANUS IN AN INFANT

To the Editors:Small linear lesions in the vicinity of classical li-

chen planus (LP) papule/plaques are due to Koeb-ner's phenomenon (1). However, violaceous pap-ules, arranged in a long, linear band (eithercontinuous or interrupted) involving at times thewhole length of a limb, characterize linear lichenplanus (LLP), though this is extremely rare. A re-view of 1,256 patients of LP revealed only threecases of LLP (2). We did not come across any LLPin a series of 17 cases of LP in children (3). ThoughLLP is more commonly seen in children as com-pared with adults, its occurrence in infants is ex-tremely rare. We report here such a case we sawrecently.

A 9-month-old-female child had violaceous,slightly scaly, puritic papules of three months' du-ration, arranged in a linear band, 1 cm in diameterextending from the lateral aspect of the right thigh.Examinations of nails, scalp, and mucosae werenormal. The lesions were nonprogressive. Histopa-thoiogy of a papular lesion revealed focal hyper-granulosis, basal cell degeneration, civatte bodyformation, and band-like lymphomononuclear infil-trate in the upper dermis. The child was prescribedclobetasol butyrate (0.5%) cream locally twicedaily. The lesions flattened, with residual postin-flammatory hyperpigmentation, over a period of 10weeks.

The dermatoses which occur in a linear distribu-tion in an infant or child and which may mimic li-chen planus closely are epidermal nevi, inflamma-tory linear epidermal nevus, porokeratosis, lichenstriatus, and psoriasis (4). However, all these havecharacteristic clinical and histopathologic featuresand usually pose no problem in differentiation. Re-cently Herd et al have expressed an opinion that lin-ear lichen planus and lichen striatus are oppositepoles of a single spectrum (2). However, we feelthat, except for the lichenoid nature of the lesions,there is no clinical or histologic similarity betweenthe two disorders.

REFERENCES

1. Rook A, Wilkinson DS, Ebling FJG. Lichen planusand lichenoid disorders. In: Champion RH, Burton

JL, Ebling FJG, eds. Text book of dermatology, 5thed. Oxford: Blackwell Scientific Publications, 1992:1685.

2. Herd RM, Mclarm KM, Aldridge RD. Linear lichenplanus and lichen striatus—opposite ends of a spec-trum. Clin Exp Dermatol 1993;18:335-337.

3. Kanwar AJ, Handa S, Ghosh S, Kaur S. Lichen pla-nus in childhood: a report of 17 patients. Pediatr Der-matol 1991;8:288-291.

4. Rook A, Wilkinson DS, Ebling FJG. Eczema, li-chenification, prurigo and erythroderma. In: Cham-pion RH, Burton JL, Ebling FJG, eds. Text book ofdermatology, 5th ed. Oxford: Blackwell ScientificPublications, 1992:580-581.

SANDIPAN DHAR, M.D., D.N.B.GAUTAM DAWN, M.D.AMRINDER J. KANWAR, M.D.Chandigarh, India

ERYTHEMA MULTIFORME FOLLOWINGHEPATITIS B VACCINE

To the Editors:Erythema multiforme (EM) is an acute self-

limited reaction which has been reported in associ-ation with a wide range of factors, including immu-nizations (1-3). We report a case of EM followingyeast recombinant hepatitis B vaccine. No previouscases of such association have been reported inchildren to our knowledge.

CASE REPORT

An 11-year-old girl received her first immunizationof yeast recombinant hepatitis B vaccine (Engerix-B) intramuscularly. Over the following days she ex-perienced fatigue and headache; she received noother drugs. Within six days of the vaccination, thepatient developed a skin rash symmetrically, in-volving the face, neck, and arms with macular andurticarial lesions, some of which showed an iris- ortarget-like appearance (Fig. 1). The right arm, thesite of the vaccination, showed diffuse erythemaand swelling. Conjunctival and mucosal surfaceswere spared. The remainder of the physical exami-nation revealed no evidence of concomitant illness.No history of recurrent sore throat, herpes simplexinfection, or similar cutaneous eruptions was given.Laboratory and virologic investigations, includinganti-Parvovirus B19 antibodies, were not signifi-cant. A clinical diagnosis of EM was made. The pa-tient was treated with oral methylprednisolon (16mg daily for two days and 8 mg daily for four days).Over the following 48 to 72 hours the erythema andswelling on the right arm rapidly receded, while themacular lesions slowly disappeared within 10 days.A patch test with ICDRG standard series performedtwo months later gave negative results.