A 38 year old male patient, engineer by an occupation, presented with minimally pruritic white colored lesions over anterior aspect of neck since 3 months. Lesions were gradually increasing in size as well as number. There was associated mild stinging sensation and minimal watery discharge from the pre-existing lesions since last two weeks. There was no history suggestive of involvement of oral or genital mucosa. The lesions were untreated till date. There were no systemic co morbidities or concurrent medication.\nDermatological examination revealed multiple atrophic papules with follicular plugging []. Closer examination revealed few lesions having a superficial wrinkled appearance which on palpation appeared to be due to the presence of atrophic epidermis overlying a collection of fluid which was confirmed after puncturing the lesion with needle []. At certain areas atrophic papules were coalescing to form plaques and few papules were studded with vesicles at their margins. Mucosae, palms, soles, nails, scalp were normal. Hematological investigations including the complete blood count, liver, renal and thyroid profiles were within normal limits. Biopsy findings from a representative lesion revealed presence of an atrophic epidermis with hydropic degeneration of basal cell layer forming a subepidermal split with pronounced dermal edema and homogenization of collagen in upper dermis and dense lymphocytic periappendageal infiltrate in the mid dermis []. A diagnosis of Bullous variant of LSA was thus established. Considering bullous nature of lesions a short course of oral and then topical superpotent steroids (clobetasol dipropionate 0.05% cream) with tacrolimus ointment (0.1%) was administered. There was clearance of lesions without any recurrence till 6 months follow up. Lesions healed with post-inflammatory hypopigmentation and scarring [].
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.