Abstract
Pattern analysis of skin lesions is an art and a key competence of every dermatologist.
Three major line patterns cover the human body—the dermatomes or Head zones, the nevoid
lines of Blaschko, and the relaxed skin tension lines, or Langer lines. Head zones
represent skin areas innervated from the same sensory neuronal segment or spinal nerve
zone. Blaschko lines are borderlines of epidermal aberration caused by genetic mosaicism
occurring in the early stages of embryogenesis. Langer lines show the direction of
the lowest naturally occurring skin tension, and its thoracodorsal manifestation is
the Christmas tree pattern. Here we review clinical aspects of pityriasis rosea, mycosis
fungoides, stage 2 syphilis, exanthematic Kaposi sarcoma, exanthematic psoriasis,
Leser-Trelat syndrome, and other primary skin diseases with a Christmas tree pattern.
Secondary skin diseases, such as herpes zoster or indeterminate cell histiocytosis,
may follow this pattern if they are linked to a primary skin disease by the Wolf isotopic
response.
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