Bullous lichen sclerosus atrophicus

Dermal Hemorrhage: A Clue to Lichen Sclerosus et Atrophicus

Lichen sclerosus et atrophicus (LSA) may present in a rare bullous and hemorrhagic form that is often difficult to recognize both clinically and histopathologically. Clinically, the lesions may be characterized by atrophic and ivory-white sclerotic plaques in both genital and extragenital regions. Histologically, fully developed lesions of LSA are characterized by a thinned, effaced epidermis with interface change, a wide band of hyalinization in the upper dermis, and a lymphohistiocytic infiltrate below the hyalinized area. Extensive vacuolar degeneration weakens the integrity of the dermoepidermal junction, which contributes to the development of marked edema in the papillary dermis and subepidermal vesiculation. With increased fragility of dermal capillaries, hemorrhage can accumulate within the bullae. Recognizing prominent upper dermal hemorrhage as a secondary change may lead to a prompt diagnosis of LSA. We present a case of extragenital LSA that mimics a dermal hemorrhage clinically and histologically in a 71-year-old Caucasian woman.

Acral bullous lichen sclerosus intolerant to UVA-1 successfully treated with narrowband ultraviolet B phototherapy

Lichen sclerosus (LS) is an uncommon, chronic, lymphocyte-mediated, inflammatory dermatosis characterized by ivory-white patches with scar-like atrophy. Extragenital bullous lichen sclerosus may rarely affect palms and soles, causing severe pain and substantially impairing quality of life. We present the first case of acral bullous lichen sclerosus intolerant to UVA-1 phototherapy successfully treated with low doses of narrowband ultraviolet B phototherapy.

Extensive bullous lichen sclerosus et atrophicus

Lichen sclerosus et atrophicus is a chronic disease of unknown etiology characterized by atrophic and sclerotic plaques in both genital and extragenital regions. Extensive bullous lichen sclerosus et atrophicus (BLSA) is a severe variant of the disease with no widely accepted treatment. We present a 63-year-old woman with extensive extragenital, ivory-colored, atrophic plaques on her trunk and extremities and disseminated hemorrhagic bullae. The patient was unsuccessfully treated with standard topical corticosteroid therapy, doxycycline and chloroquine. According to the literature, there is little evidence of the efficacy of doxycycline and hydroxychloroquine in the treatment of BLSA. We report a rare case of extensive BLSA that is unresponsive to these drugs.

Extragenital bullous lichen sclerosus in a pediatric patient: a case report and literature review

A 14-year-old girl presented with a 1-year history of a pruritic, bullous lesion on her posterior neck. A biopsy revealed bullous lichen sclerosus. Although unusual, this bullous variant of lichen sclerosus is well recognized in the adult literature, but extragenital bullous and hemorrhagic lesions are rare in children. A review of this case and the literature describes the clinical features, pathophysiology, and treatment options for this extragenital bullous variant in an effort to raise awareness of this rare clinical presentation.