Generalized morphoea, lichen sclerosus et atrophicus and primary biliary cirrhosis

Extragenital lichen sclerosus: A comprehensive review

Lichen sclerosus (LS) is a chronic inflammatory mucocutaneous disease of unknown aetiology. About 85% of total cases of LS are genital cases, while extragenital form is seen in only 15-20% of cases. Extragenital LS (EGLS) can occur simultaneously with genital form; however, in 6% of the cases, only extragenital form has been described. Genetic, autoimmune, infectious, environmental and hormonal factors are implicated in its aetiology. Extragenital LS presents as asymptomatic white opalescent papules, which cluster in plaques and slowly progress over time resulting in parchment-like skin usually involving upper trunk, neck and shoulders. Lesions are frequently accompanied by purpura/haemorrhagic spots. The relationship with morphoea has been a topic of debate. Association with several autoimmune diseases has been observed. Diagnosis is usually based on clinical and dermoscopic examination and further supported by histopathological findings. LS needs to be differentiated from several other dermatological conditions such as discoid lupus erythematosus, vitiligo, mycosis fungoides (hypopigmented variant), lichen planus, graft-versus-host disease and morphoea depending upon the stage of the disease. Generally, extragenital LS is believed to lack carcinogenic potential. However, case reports with possible malignant transformation have been described. In this article, the authors have described a concise review of the extragenital form of LS.

Generalized morphea and primary biliary cirrhosis coexisting in a male patient

We present further evidence that generalized morphea (GM) and primary biliary cirrhosis (PBC) may be associated. As far as we know, only six cases with this association have been previously reported in the published work, all of which were observed in women. We describe the case of a 62-year-old man diagnosed with M2-antibody-positive PBC who developed multiple generalized indurated plaques on the trunk and extremities 3 years later. Clinical history, laboratory data and histopathological examination were consistent with the diagnosis of GM. The coexistence in a male of these two entities that predominantly affect females reinforces the hypothesis that a pathogenic link exists between GM and PBC. Consequently, PBC should be looked for in all patients with GM.

Lichen sclerosus and eosinophilic fasciitis as manifestations of chronic graft-versus-host disease: expanding the sclerodermoid spectrum

Chronic cutaneous graft-versus-host disease (GVHD) is classically divided into two major clinical categories--lichenoid and sclerodermoid. Although diffuse areas of sclerosis as in scleroderma characterize the more advanced stages of the sclerodermoid form, the initial circumscribed plaques would be more correctly described as morpheaform. Eosinophilic fasciitis (EF) (a fibrosing disorder related to deep morphea) and lichen sclerosus (LS) have also been reported as manifestations of sclerodermoid GVHD. However, these two presentations of GVHD have not been emphasized in the dermatologic literature. We describe 6 patients, all of whom developed LS and two of whom also developed EF in the context of chronic GVHD. Each patient presented clinically with hypopigmented plaques that exhibited wrinkling, scaling, and follicular plugging. These lesions demonstrated the classic histologic features of LS including epidermal atrophy; a subepidermal zone of pale-staining, homogenized collagen; and a bandlike lymphocytic infiltrate. Although all patients eventually developed morpheaform and/or sclerodermoid GVHD, LS was a prominent part of the initial presentation of chronic cutaneous GVHD in every case. The LS lesions tended to occur on the neck and upper to mid aspect of the trunk, whereas morpheaform lesions favored the lower aspect of the trunk. EF involved the extremities (sparing the hands and feet), and was characterized clinically by an acute onset of pain and edema followed by induration with a rippled appearance. This case series serves to expand the spectrum of sclerodermoid GVHD, with LS as the most superficial and EF as its deepest manifestation.

Necrotizing vasculitis in a patient with generalized morphea

Generalized morphea is rarely associated with systemic overlap. We report an unusual case with generalized morphea involving cutaneous large vessel vasculitis, mononeuritis multiplex, and lupus anticoagulant without any evidence of the coexistent systemic lupus erythematosus.

Genital lichen sclerosus associated with morphoea or systemic sclerosis: clinical and HLA characteristics

Although patients with both morphoea and lichen sclerosus have been reported previously, in the majority of these reports the lichen sclerosus has been extragenital. We report nine patients in whom genital lichen sclerosus coexisted with scleroderma spectrum disorders including seven with morphoea, one with morphoea and lichen planus, and one with systemic sclerosis. The clinical features, associated autoimmune disease, autoantibodies and HLA type are reported. Antibodies to Borrelia burgdorferi were not detected in any of the patients. The coexistence of these diseases raises a number of intriguing questions about the relationship between them.

Lichen sclerosus et atrophicus in a band-like arrangement

We report a case of lichen sclerosus et atrophicus (LSA) in a band-like arrangement. The patient had a white atrophic plaque on the left breast which showed the typical histological features of LSA. One month later, the patient had developed multiple, brown-colored plaques from the right breast to the right upper arm following the distribution of the peripheral nerve. These plaques showed the mild histological changes indicative of LSA. This band-like arrangement of LSA appears to be unique.

A case of linear type of lichen sclerosus et atrophicus?

We report a case of the linear type of lichen sclerosus et atrophicus (LSA). The patient had linear atrophic lesions from the left upper back to the left hand. Histological findings obtained from the upper back were those of typical LSA. Histology of the forearm showed mild changes suggestive of LSA. There were no histological features suggesting any association with localized scleroderma in either specimen. The relation between LSA and localized scleroderma is unclear at present. This case suggests that there is a linear form in LSA as already recognized in localized scleroderma.

Lichen sclerosus

Lichen sclerosus, usually appearing in the dermatologic literature under the names of lichen sclerosus et atrophicus, balanitis xerotica obliterans, and kraurosis vulvae, is an inflammatory disease with a multifactorial origin. A past association of lichen sclerosus and genital squamous cell carcinoma is not as close as once thought. Once considered primarily a surgical problem, especially when the genitals were involved, lichen sclerosus will respond to a variety of systemic and topical therapies.

Morphea coexisting with lichen sclerosus et atrophicus

A 65-year-old woman presented with four autoimmune diseases. These include morphea, lichen sclerosus et atrophicus, insulin-dependent diabetes mellitus, and autoimmune thyroid disease. The relationship between morphea and lichen sclerosus et A is discussed, as is the link between these conditions and autoimmunity.

Localized scleroderma

Localized scleroderma has no recognized internal organ involvement. It may rarely coexist with a systemic connective tissue disease, but is not thought to progress to systemic sclerosis. Although never fatal, localized scleroderma may cause considerable disability from joint contractures and subcutaneous atrophy. Facial lesions are particularly disfiguring and may be accompanied by hemiatrophy. Serum auto-antibodies are common but do not imply systemic disease. The presence of ANAs or antibodies to ssDNA correlates directly with more extensive and prolonged disease. Blood eosinophilia may be striking, and its presence correlates with active disease. Patients with elevated serum IgG appear to be at a greater risk for the subsequent development of contractures. These laboratory abnormalities are useful in determining prognosis and during follow-up. No accepted and effective treatment exists. Physical therapy should be instituted immediately in all patients at risk for contractures. Systemic corticosteroids, used early in patients with active and widespread involvement, can be expected to improve the inflammatory phase. A variety of systemic agents have been reported to be helpful, but no controlled studies exist on their effectiveness.

Lichen sclerosus et atrophicus with ocular and maxillary complications

An unusual case of lichen sclerosus et atrophicus (LSA) with extracutaneous manifestations is described and the relationship between LSA and morphoea is discussed.