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 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.