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.
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.