Linear lesions of the skin may be secondary to several disease processes.
GENETIC Incontinentia pigmenti INFLAMMATORY Lichenoid contact or phytophoto- dermatitis
Lichenoid drug eruption
Inflammatory linear verrucous epidermal nevus
PATHOGENESIS CHARACTERIZATION Lines of Blaschko
In 1901, Alfred Blaschko presented, on the occasion of the 7th Congress of the German Dermatological Society held in Breslau, a system of “nevus lines”. In his words, “I have tried…to delineate, from the total collection of available cases, a system of lines on the surface of the body representing the typical pattern that the linear nevi follow.”
He analyzed 170 case reports that he had received from colleagues of all parts of Europe he delineated an archetype of lines as observed in many congenital and some acquired skin disorders
These may represent a clinical expression of a genetically programmed clone of altered cells, perhaps first expressed during embryogenesis
Pigmentary disorders Nevus achromicus (including hypomelanosis of Ito)
Linear hyperpigmentation arranged in small bands
Linear hyperpigmentation arranged in broad bands (McCune-Albright syndrome)
Epithelial Nevi Sebaceous nevus including Schimmelpennig syndrome
Nonorganoid epidermal nevus (epidermolytic or nonepidermolytic type) Inflammatory linear verrucous epidermal nevus
X-linked dominant skin disorders X-linked dominant skin disorders
Focal dermal hypoplasia
X-linked dominant chondrodysplasia punctata
Oral-facial-digital syndrome type 1
Acquired Acquired skin disorders with a polygenic background
Linear lichen planus
Linear lupus erythematosus
The lines of Blaschko on the head and neck
Rudolf Happle, etal.
J Am Acad Dermatol 2001;44:612-5 Abstract quote
Background: The system of Blaschko's lines has been insufficiently documented on the head and neck.
Objective: The aim of the study was to elaborate this pattern in a comprehensive way.
Method: One hundred eighty-six figures showing skin lesions following Blaschko's lines on the head and neck were collected from literature and patient files, transposed into drawings, and subsequently categorized according to 3 standard perspectives. Transparent sheets were superimposed to delineate an archetypical pattern.
Results: The definite lines are presented in a frontal, lateral, and dorsal view. On the face they show an hourglass-like configuration converging on the nasal root. However, in several areas these lines intersect at an angle of almost 90°. On the scalp they form a spiral configuration.
Conclusion: The system of Blaschko's lines on the head and neck as elaborated by this study is more precise than previously published diagrams. Remarkably, this archetypical pattern shows definite crossing of lines.
Fitzpatrick's Dermatology in General Medicine. 5th Edition. McGraw-Hill. 1999.
Last Updated 4/8/2001
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