Eosinophils in biopsy specimens of lichen sclerosus: a not uncommon finding

Abstract

Epidermal hyperplasia, epidermotropism of lymphocytes and basement membrane thickening are helpful features in identifying early LS. Eosinophils are not an uncommon finding in LS and are most common in male genital lesions and in LS associated with SCC.

Eosinophils in lichen sclerosus et atrophicus

“…Twenty‐five percent of their cases also showed spongiotic dermatitis, and 5% of those specimens exhibited eosinophilic spongiosis; the authors noted a correlation between persistent and progressive pruritus and the presence of eosinophils. Lester and Swick reported an association between eosinophils in LS and squamous cell carcinoma. None of our patients with LS also had an associated squamous cell carcinoma.…”

“…Because the main goal of our study was to evaluate an association between LS and associated allergic or autoimmune disease, we chose to use the classic histopathology as the gold standard for diagnosis, because photographs to verify the clinical diagnosis were inconsistently available, particularly of genital disease. We thus probably excluded patients with biopsies that exhibited histopathological features compatible with but not specific for LS, including interface dermatitis and epidermal acanthosis or atrophy because such patterns also may be seen in the disease associations we sought to determine. The presence of eosinophils has been shown in early or transitional cases of LS; however, this observation was not statistically significant when compared with cases of well developed LS.…”

“…We thus probably excluded patients with biopsies that exhibited histopathological features compatible with but not specific for LS, including interface dermatitis and epidermal acanthosis or atrophy because such patterns also may be seen in the disease associations we sought to determine. The presence of eosinophils has been shown in early or transitional cases of LS; however, this observation was not statistically significant when compared with cases of well developed LS. We also excluded cases that showed deep dermal fibrosis suggestive of morphea or morphea‐LS overlap.…”

“…Clinical features of vulvar pemphigoid may resemble those of LS . Most recently, Lester and Swick found that eosinophils are particularly common in male genital lesions of LS and in LS associated with squamous cell carcinoma. We therefore sought to determine whether the finding of dermal eosinophils or eosinophilic spongiosis (or both) in biopsy specimens of LS may be a clue to coexistent immunobullous disease, autoimmune disease or allergic contact dermatitis.…”

Lichen sclerosis: clinicopathological study of 60 cases from Lebanon

“…Compared to extragenital LS, genital LS may additionally exhibit spongiotic dermatitis changes and epidermal hyperplasia at times severe enough to be pseudoepitheliomatous . Additional uncommon or rare microscopic features reported with LS include the presence of eosinophils, angiokeratoma (AK)‐like changes, epidermotropic lymphocytes mimicking mycosis fungoides (MF)/cutaneous T‐cell lymphoma, and milia formation …”