Case 335 Medical history Male patient, 23 years old, presents hyperchromic lesions in the left dimidium and the cervical region, asymptomatic, evidenced at birth and showing progressive evolution with growth and darkening. He denies family history of similar lesions. He presented episodes of diarrhea and involuntary movimentation of the right dimidium since he was 16 years old, when diagnosed with right hemichorea. Imagem 1: Máculas e placas hipercrômicas, acastanhadas, na região do hemidimídio esquerdo, seguindo as linhas de Blaschko.Imagem 2: Placa hipercrômica, marrom escuro, de limites bem definidos, bordas irregulares e superfície verrucosa na região cervical anterior do paciente, apresentando aproximadamente 4,5 cm em seu maior diâmetro.Imagem 3: Pápulas e placas amarronzadas, com bordas irregulares e limites precisos, na região posterior do dimídio esquerdo do paciente, seguindo as linhas de Blaschko. Question:Considering the clinical history and the presented images, what is the most likely diagnosis? Lichen striatus. Linear psoriasis. Epidermal nevus syndrome. Darier Disease. Test Question (FHEMIG Dermatology Medical Residency - 2009) The Blaschko lines are a characteristic pattern of linear distribution of skin lesions. About these lines, it is INCORRECT to affirm that: They differ from the Langer lines which are minimum tension lines of the skin. They result from the mosaicism due to the lyonization phenomenon, the somatic mutations, the chromosome nondisjunction and chimerism. They result from the skin cells connection at embryogenesis, representing the division between normal cells and mutant cells populations. They correspond to the dermatomes correlating with the distribution of vascular and nervous structures. Time is Up! Time's up
