Female patient, 55 years old, dental assistant, evolved with asymptomatic lesions on the\nback and upper limbs for three years. At the dermatological examination, whitish plaques\nof hardened consistency, with well-defined borders and horny spikes were observed on the\nback and upper limbs. There were also plaques with hemorrhagic aspect, with superficial\nhorny spikes and blisters, located on the back (). During this time of evolution, she underwent two cutaneous biopsies at\nprevious evaluations carried out at other outpatient clinics, with histological\ndiagnosis suggesting circumscribed lymphangioma and scleroderma plaque, respectively.\nShe was referred to a REFERENCES center, undergoing a new biopsy; the histopathological\nexamination revealed atrophic epidermis, with hyperkeratosis and follicular plugs.\nVacuolar degeneration of the basal layer was observed in the dermis, with subepidermal\nblisters and extravasation of red blood cells. Edema and collagen homogenization in\npapillary dermis were also observed, with a perivascular lymphohistiocytic inflammatory\ninfiltrate, confirming the diagnosis of bullous and hemorrhagic lichen sclerosus (). Routine laboratory tests did not show\nother changes. The patient was treated with high-potency topical corticoid, evolving to\nremission of the hemorrhagic bullous lesions after 2 months of treatment. She remains\nunder clinical follow-up, with hyperkeratotic lesions on the back ().
A 22-year-old male had atrophic, hypopigmented macules and papules over chest, trunk and lower limbs since 5 months. Dermoscopy revealed WSA, white chrysalis like structures (WCLA) and telangiectasia of different lengths and calibers [Figure and ].\nHistopathology of lesions showed atrophy of the epidermis, hyperkeratosis [], and follicular plugging with basal cell degeneration. [] The dermis showed edema and homogenization of collagen and interstitial and perivascular lymphocytic infiltration [].\nHair, nail, oral, genital mucosa, systemic examination, and blood investigations were within normal limits in all three patients. A diagnosis of extragenital LS was made in all three cases based on clinical features and histopathology.