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 [].
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.