The lines of Blaschko: a review and reconsideration: Observations of the cause of certain unusual linear conditions of the skin

Abstract

Blaschko's lines are the pattern assumed by many different naevoid and acquired skin diseases on the human skin and mucosae. They were described and drawn by Blaschko 75 years ago. These lines are to be distinguished from other linear patterns such as Voight's lines, Langer's lines, and the lines of innervation of the spinal nerves. They do not follow any known nervous, vascular or lymphatic structures in the skin. The epidermis and its appendageal structures, the melanocytes, the vascular system, and the fatty hypoderm, all, separately or in combination, may be involved in the morphological manifestations which follow Blaschko's lines. Many of the naevoid skin conditions are lifelong (e.g. linear sebaceous naevus, unilateral naevoid telangiectasia); many of the acquired skin diseases (e.g. lichen striatus, linear psoriasis) are of relatively short duration (e.g. 1-2 years). The cause of the distribution pattern is unknown. It is possibly a form of human 'mosaicism' where certain specific cells or groups of cells react differently from other cells due to chromosomal abnormalities. The embryological explanation of Blaschko's lines is not at all clear. Other markers in addition to the skin findings are needed to determine the time and the nature of the change responsible for these lines. The main purpose of this article is to introduce the concept of Blaschko's lines into the medical, paramedical, and general biological fields of science. In this way, it is hoped that some inter-reaction can occur between those who regularly see Blaschko's lines and those who regularly see and study other chromosomal and embryological abnormalities.