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 71-year-old Caucasian female patient with no prior history of skin cancer presented with a red, painful, and enlarging plaque on her right breast for several weeks. This lesion has not been treated in the past and she denies genital lesions.\nPhysical exam revealed a hemorrhagic plaque with subtle surrounding atrophic changes on her right medial breast (Figure ). Punch biopsy of the plaque revealed hyperkeratosis with epidermal atrophy, prominent papillary dermal edema with homogenization, and extensive hemorrhage at the dermoepidermal junction, suggestive of LSA (Figure ). Unfortunately, the patient was lost to follow-up and did not receive treatment.