Dermal Hemorrhage: A Clue to Lichen Sclerosus et Atrophicus

Abstract

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.

Extensive isolated extragenital hemorrhagic bullous lichen sclerosus in a 75-year-old Yemeni woman: A case report

“…7 The breasts are commonly and severely affected. 4 In this case, both breasts were severely affected, with atrophic wrinkled skin and a few hemorrhagic bullae (Figure 1A).…”

“…1 Clinically, extragenital lesions present as whitish papules and plaques with wrinkled surfaces and superficial horny plugs. 4 They are seldom pruritic but are usually asymptomatic. Herein, we report a case of extensively isolated extragenital bullous and hemorrhagic LS, an atypical and extremely rare variant of the disease.…”

Extragenital lichen sclerosus: A comprehensive review

“…In such cases, histopathology shows predominant dermal haemorrhage, giving a clue to diagnose LS. 42 T A B L E 4 Differences between lichen sclerosus and morphoea 2,17,39,40…”

“…Very rarely, patients present with haemorrhagic bullae/purpuric lesions without classical plaques of LS, which may appear later in the disease course making clinical diagnosis difficult. In such cases, histopathology shows predominant dermal haemorrhage, giving a clue to diagnose LS 42 …”

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