We report a 63-year-old woman with a few months' history of cutaneous lesions on her\ntrunk and extremities. Histopathological analysis of the lesions revealed lichen\nsclerosus et atrophicus (LSA), which were treated with topical corticosteroids.\nPersonal and family history was unremarkable. Our first examination revealed\nmultiple, disseminated, hypopigmented and hyperpigmented atrophic and sclerotic\nplaques on her trunk and extremities. The patient presented a 6x8cm fragile,\nhemorrhagic bulla within an atrophic plaque on her lower back (). We performed an incisional biopsy of the bulla that\nrevealed epidermal atrophy, a subepidermal blister with marked edema of the\npapillary dermis and homogenization of collagen (). Blood count, biochemical parameters and coagulation studies\nwere within the normal range. Immunological analyses revealed positive (1:160)\nantinuclear antibodies (ANAs) by indirect immunofluorescence (Hep-2-cells)\n(homogenous pattern), and negative anti-ssDNA, anti-dsNA, anti SSA/Ro,Scl-70 and\nanti-SSB/ La. IgG and IgM (EIA) antibodies were negative for Lyme's disease. Chest\nX-ray, abdomen ultrasound and gynecological examination showed no pathological\nfindings. The patient was initially treated with doxycycline 100 mg/ day and locally\napplied 0, 5% clobetasol. The bulla resolved within three weeks, but new hemorrhagic\nbulla appeared in the same place together with painful, non-hemorrhagic bullae on\nboth gluteal regions (). Chloroquine\nwas administered in daily doses of 250 mg. After a month, we observed some\nimprovement of the skin lesion and resolution of the bulla on the back, but soon\nafter, new multiple hemorrhagic bullae appeared on the trunk ( and ). We\nobserved no erosion healing on the sites of previous bullae in the gluteal regions,\nwhere shallow, painful ulcers were formed. The patient refused the advised\nhospitalization and further follow-up appointments.
A 67-year-old woman, without remarkable medical or family background, presented with a\n6month history of a pruritic sclerotic lesion on her abdomen. The sclerotic lesion had\nbeen accompanied by a blister on the back of the right foot for 4 months and there had\nbeen no previous trauma. Physical examination revealed several 2-4 cm, ivory colored,\nshiny, sclerotic lesion on the abdomen ()\nand soft plaque on the back of the right foot (). There were no other lesions on her body. An incision-al biopsy specimen\nrevealed hyperkeratosis, atrophy of the epidermis, marked edema in the upper dermis\nresulting in a subepidermal blister and homogenization of collagen in the papillary\ndermis ().\nAfter the diagnosis of Bullous lichen sclerosus et atrophicus was made, we started\ntreatment with topical corticosteroid and achieved stabilization and slight improvement.