Histochemical differentiation of localized morphea‐scleroderma and lichen sclerosus et atrophicus

Abstract

Dermatologic literature has debated the occurrence of concomitant morphea-scleroderma (M-S) and lichen sclerosus et atrophicus (LSA) for sometime. Presentation of a case which has the appearance of both M-S and LSA creates a diagnostic dilemma frequently unresolved even by histopathology. Routine hematoxylin and eosin stained sections may add to the confusion and the difficulty of the differentiation, but examination for the presence or absence of elastic fibers in the upper corium of the lesions affords a definitive separation of these two conditions.

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

“…46 However, most investigators ascribe findings such as follicular plugging, epidermal thinning with vacuolar basal alteration, homogenization of the papillary dermis with loss of elastic fibers, and a lichenoid infiltrate to LS, not morphea. 24,26,47 These authors acknowledge that LS and morphea are related, but view them as distinct clinicopathologic entities. 24,26,47 They, therefore, interpret skin lesions displaying the aforementioned features together with thickened collagen bundles in the lower reticular dermis as an overlap between LS and morphea.…”

“…24,26,47 These authors acknowledge that LS and morphea are related, but view them as distinct clinicopathologic entities. 24,26,47 They, therefore, interpret skin lesions displaying the aforementioned features together with thickened collagen bundles in the lower reticular dermis as an overlap between LS and morphea. 23,24 In the context of GVHD, the histologic differences between LS and morpheaform lesions may be less apparent.…”

Alterations of Basement Membrane Zone and Cutaneous Microvasculature in Morphea and Extragenital Lichen Sclerosus

“…Pronounced edema and homogenization of collagen appear alongside the loss of elastic fibers in the upper dermis. [12][13][14] A thickened basement membrane is of diagnostic significance in LS. 22,23 At the ultrastuctural level, abnormalities of the BMZ are observed, [24][25][26] consisting of absence of anchoring fibrils, as well as invaginations and reduplications of the basal lamina.…”

“…The elastic fibers are preserved and also present in superficial layers below basement membrane zone, a main histologic feature allowing differentiation from lichen sclerosus. [12][13][14] Lichen sclerosus (LS) is a chronic disease that occurs in all age groups, in both sexes and at most skin sites, frequently affecting the anogenital area in perimenopausal women, leading to urogenital complications. 1,[15][16][17] Extragenital LS starts as small, somewhat hyperkeratotic papules that evolve into atrophic, shiny, white patches resembling morphea.…”

Early localized morphea mimicking an acquired port-wine stain

“…It affects the cheek and mandible areas and, in many cases, the affected skin is initially erythematous and may resemble a PWS. 6 Although the origin of morphea remains unknown, proposed theories suggest that abnormal metabolism and collagen turnover, 8 trauma, 9 and infectious agents such as the Borrelia species may play a role. 10 Vascular damage, such as microvascular injury, and T-cell activation, which induces abnormal collagen production by fibroblasts, are thought to be involved.…”