Wickham striae

Fine white lines or dots seen on the surface of lichen planus lesions

Wickham striae are a clinical feature observed in certain dermatological conditions, most notably in lichen planus. They appear as fine, white, lace-like lines or dots on the surface of the lesions. These striae are named after Louis Frédéric Wickham, a French dermatologist who first described them.

Clinical Presentation

Wickham striae are most commonly associated with lichen planus, a chronic inflammatory condition that affects the skin and mucous membranes. The striae are typically seen on the surface of the violaceous, flat-topped papules characteristic of lichen planus. They are more easily observed when the lesions are moistened or viewed under a magnifying glass.

Lichen planus lesions with Wickham striae

In addition to lichen planus, Wickham striae can occasionally be seen in other dermatological conditions, such as lichen nitidus and lichen sclerosus. However, their presence is most diagnostic of lichen planus.

Pathophysiology

The exact mechanism behind the formation of Wickham striae is not fully understood. It is believed that the striae result from the presence of hypergranulosis, which is an increase in the granular layer of the epidermis. This layer contains keratohyalin granules, which may contribute to the white appearance of the striae when light is reflected off the skin surface.

Diagnosis

The diagnosis of Wickham striae is primarily clinical, based on the characteristic appearance of the lesions. A dermatologist may use a dermatoscope to enhance the visualization of the striae. In some cases, a skin biopsy may be performed to confirm the diagnosis of lichen planus or to rule out other conditions.

Management

There is no specific treatment for Wickham striae themselves, as they are a symptom rather than a condition. Management focuses on treating the underlying condition, such as lichen planus. Treatment options may include topical corticosteroids, systemic medications, or phototherapy, depending on the severity and extent of the disease.

Prognosis

The presence of Wickham striae does not affect the prognosis of the underlying condition. In lichen planus, the lesions may resolve spontaneously over time, although they can also persist for years. Regular follow-up with a healthcare provider is recommended to monitor the condition and adjust treatment as needed.

Related Pages

• Lichen planus
• Lichen nitidus
• Lichen sclerosus
• Dermatology