Abstract: Gu Ankang, Zhang Junling, Jiang Junqing, Kong Xiangjun, Xiao Yin, Ji Hua′an Department of Pathology, Tianjin Academy of Traditional Chinese Medicine Affiliated Hospital, Tianjin 300120, China （Gu AK, Xiao Y, Ji HA）; Department of Dermatology, Tianjin Academy of Traditional Chinese Medicine Affiliated Hospital, Tianjin 300120, China （Zhang JL, Jiang JQ, Kong XJ） Corresponding author: Gu Ankang, Email: guankang163.com@163.com 【Abstract】 Objective To investigate reflectance confocal microscopy （RCM） characteristics of childhood hypopigmented lichen striatus. Methods RCM was performed to image skin lesions and perilesional normal skin in 11 children with hypopigmented lichen striatus. Then, confocal microscopic findings of the skin lesions were compared with pathological findings. Results Histopathological examination of the skin lesions showed mild intercellular and intracellular edema, thickening of prickle cell layer to different extent, local liquefaction degeneration of basal cells, and perivascular infiltration of plenty of lymphocytes and a few melanophages in the superficial dermis. RCM horizontal images showed multifocal liquefaction degeneration of basal cells, which caused indistinct dermo-epidermal junction, incomplete or unclear dermal papillary rings, infiltration of many highly refractive melanophages and slightly to moderately refractive inflammatory cells in papillary and superficial dermis. Conclusion RCM characteristics can serve as strong evidences for the diagnosis and differential diagnosis of childhood hypopigmented lichen striatus.