Dermatology: Practical and Conceptual Commentary | Dermatol Pract Concept. 2025;15(1):5108 1 Dermoscopy in the Diagnosis of Keratosis Lichenoides Striata (Nekam Disease): A Rare Clinical Entity Caterina Mariarosaria Giorgio1, Eugenia Veronica Di Brizzi1, Anna Balato1, Paolino Franzese1, Nicola Maria Giorgio1, Gaetano Licata2 1 Dermatology Unit, Department of Mental and Physical Health and Preventive Medicine, University of Campania Luigi Vanvitelli, Naples, Italy 2 Dermatology Unit, San Antonio Abate Hospital, Trapani, Italy Key words: Dermoscopy, Keratosis Lichenoides Striata, Nekam Disease, Clinical Dermatology Citation:Giorgio CM, Di Brizzi EV, Balato A, Franzese P, Giorgio NM, Licata G. Dermoscopy in the Diagnosis of Keratosis Lichenoides Striata (Nekam Disease): A Rare Clinical Entity. Dermatol Pract Concept. 2025;15(1):5108. DOI: https://doi.org/10.5826/dpc.1501a5108 Accepted: October16, 2024; Published: January 2025 Copyright: ©2024 Giorgio et al. This is an open-access article distributed under the terms of the Creative Commons Attribution- NonCommercial License (BY-NC-4.0), https://creativecommons.org/licenses/by-nc/4.0/, which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original authors and source are credited. Funding: None. Competing Interests: None. Authorship: All authors have contributed significantly to this publication. Ethics Statement: The patients in this manuscript have given written informed consent to publication of their case details. This study follows the ethics guidelines. Corresponding Author: Gaetano Licata, MD, Dermatology Unit, San Antonio Abate Hospital. Via Cosenza 82, 91016, Erice (TP), Italy. Phone: 3276215976. E-mail gaetano.licata89@gmail.com Introduction Keratosis lichenoides striata (KLS) is a rare, self-limiting linear dermatosis of unclear etiology primarily affecting children and young adults [1]. The lesions are typically dis- tributed along the lines of Blaschko, believed to represent embryonic developmental patterns of epidermal cells. Al- though KLS resolves spontaneously, its clinical overlap with psoriasis, lichen planus, and eczema can complicate diagno- sis [2]. Dermoscopy has emerged as an effective diagnostic tool to differentiate KLS from these conditions. Dermoscopic Findings Background Color KLS lesions display a milky pink hue, which transitions to a red base. This background is a distinguishing feature and reflects underlying superficial perivascular lympho- cytic infiltrate seen histologically, differentiating KLS from psoriasis, which often shows a more uniformly erythema- tous base. 2 Commentary | Dermatol Pract Concept. 2025;15(1):5108 Figure 1. (A, B) Clinical images of a 63-year-old woman affected by keratosis lichenoides striata. Scales and Crusts KLS is characterized by irregular, unevenly distributed scales or crusts. This contrasts with the uniform, silvery scales typically seen in psoriatic plaques, providing an important diagnostic clue. The uneven scaling reflects areas of paraker- atosis and hyperkeratosis, indicating epidermal proliferation secondary to chronic inflammation. Vascular Structures The vascular pattern in KLS consists of dotted and glo- merular vessels, distributed irregularly across the lesion. This contrasts with the more regularly spaced dotted ves- sels seen in psoriasis. Dotted vessels correspond to dilated capillaries in the superficial dermis, while glomerular ves- sels signify increased vascularization in more inflamed areas (Figures 1 and 2). Differential Diagnosis on Dermoscopy Psoriasis Psoriatic plaques typically feature uniformly distributed dot- ted vessels against a bright red background, along with thick, silvery white scaling. In contrast, KLS has irregular scaling and scattered dotted or glomerular vessels. Lichen Planus Lichen planus shows hallmark Wickham striae, which are absent in KLS. Lichen planus also tends to have a viola- ceous hue, while KLS presents with a pink background. Vascular patterns in lichen planus are less pronounced com- pared to KLS. Eczema Eczema may present with yellow serocrusts, reflecting exudation, which is absent in KLS. The vascular pattern in eczema typically consists of linear vessels, as opposed to the dotted and glomerular vessels of KLS. Conclusions Keratosis lichenoides striata is a rare, self-limiting condi- tion that can mimic more common inflammatory dermato- ses. Dermoscopy plays a crucial role in differentiating KLS by identifying features such as a milky pink background, irregular scaling, and variable vascular patterns [3]. By correlating these dermoscopic findings with histopathol- ogy, clinicians can achieve an accurate diagnosis without unnecessary biopsies, thus improving patient management and care. Commentary | Dermatol Pract Concept. 2025;15(1):5108 3 References 1. Leung AKC, Lam JM, Barankin B, Leong KF. Lichen Striatus: An Updated Review. Curr Pediatr Rev. 2024. DOI: 10.2174/011573 3963273945240101042423. PMID: 38279714. 2. Mendiratta V, Meena AK. Clinical and epidemiological profile of lichen striatus in children-Experience from a tertiary care hospital. Pediatr Dermatol. 2023;40(4):642-3. DOI: 10.1111/pde .15345. PMID: 37290834. 3. Kim DW, Kwak HB, Yun SK, Kim HU, Park J. Dermoscopy of lin- ear dermatosis along Blaschko’s line in childhood: Lichen striatus versus inflammatory linear verrucous epidermal nevus. J Der- matol. 2017;44(12):e355-6. DOI: 10.1111/1346-8138.14035. PMID: 28925078. Figure 2. (A-D) Dermoscopic images of keratosis lichenoides striata; a background with milky pink hues, scales, and glomerular/dotted vessels are highlighted.