Ann Dermatol.  2011 Dec;23(Suppl 3):S354-S359. 10.5021/ad.2011.23.S3.S354.

A Case of Lichen Sclerosus et Atrophicus Accompanying Bullous Morphea

• Yasar S
• Mumcuoglu
• Serdar ZA
• Gunes P

• KMID: 2171871
• DOI: http://doi.org/10.5021/ad.2011.23.S3.S354

Abstract

Bullous morphea is a rare form of morphea characterized with bullae on or around atrophic morphea plaques. Whereas lichen sclerosus et atrophicus (LSA) is a disease the etiology of which is not fully known, and which is characterized with sclerosis. Coexistence of morphea and LSA has been identified in some cases. Some authors believe that these two diseases are different manifestations which are on the same spectrum. The 70-year-old patient stated herein, presented to us for 6 months with annular, atrophic plaques, ivory color in the middle, surrounded by living erythema, on the front and back of the trunk. Occasionally bulla formation on the plaques on the trunk lateral was identified. Fibrotic and atrophic plaques of ligneous hardness were present on the front side of tibia of both legs. In the histopathologic examination, the lesions were found concordant with bullous morphea and LSA. With colchicine 1.5 mg/day, pentoxifylline 1,200 mg/day, topical calcipotriol ointment and clobetasol propionate cream, the erythema in the patient's lesions faded and softening in the fibrotic plaques was observed. Concomitance of bullous morphea and LSA is a rarely seen, interesting coexistence which suggests a common, as yet unknown, underlying pathogenesis.

Keyword

Lichen sclerosus et atroficus; Scleroderma; localised

MeSH Terms

Aged
Blister
Calcitriol
Clobetasol
Colchicine
Erythema
Hardness
Humans
Leg
Lichen Sclerosus et Atrophicus
Lichens
Pentoxifylline
Scleroderma, Localized
Sclerosis
Tibia
Calcitriol
Clobetasol
Colchicine
Pentoxifylline

Figure

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  Fig. 1 (A~C) Circinate, atrophic plaques surrounded by living erythema. Indurated plaques, whcih are bullous in the middle. (D) Fibrotic plaques on the anterior aspect and surface of the tibia.

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  Fig. 2 (A, B) Epidermal atrophy and flattening of the rete ridges, vacuolar degeneration in the basal layer, edema in the papillary dermis (H&E, ×40, 100). (C, D) Subepidermal detachment in a focal area, coarsened collagen fibers (H&E, ×40, 100).

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  Fig. 3 (A, B) Decrease of elastic fibers in lichen sclerosus et atrophicus (elastic von Gieson, ×40, 100), (C, D) Normal limits of elastic fibers in morphea (elastic von Gieson, ×40, 100).

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  Fig. 4 (A~C) In lichen sclerosus et atrophicus, normal collagen fibers (Masson's trichrome, ×40, 100, 200), (D~F) coarse, sclerosing collagen fibers in morphea (Masson's trichrome, ×40, 100, 200).

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