Co-existence of Lichen Sclerosus et Atrophicus and Morphoea Along Lines of Blaschko
A 40-year-old female presented with slightly pruritic eruption that initially started over the left shoulder 2 years back and then gradually enlarged to involve the left arm, left side of her abdomen, and the left lower limb. The lesions reached the present size 1 year back and remained stable since then. An examination revealed discrete and confluent, porcelain white, sharply circumscribed, slightly atrophic, papuloplaques over the left arm and left leg and left side of abdomen with a sharp demarcation at the midline [Figures and ]. Several areas showed cigarette paper wrinkling suggestive of atrophy of epidermis. The genital, perianal, and the mucosal areas were normal. The skin over the posterolateral aspect of abdomen on the left side and over the lower part of thigh was slightly hyperpigmented and indurated. Over this affected area the epidermal changes were missing and the overlying skin was smooth.\nRoutine hemogram and urine examination were within normal limits. Biopsy done from the area with porcelain-white discoloration of epidermis showed follicular plugging overlying a thinned out epidermis devoid of rete ridges. Vacuolar alteration of basal cell layer was present. Moderate papillary dermal edema along with focal homogenization of the collagen was present. Periadnexal lymphohistiocytic infiltrate was evident in the dermis. The findings were consistent with LS []. Histopathology done from the smooth, hyperpigmented, and indurated lesion on the left flank showed a relatively normal epidermis without follicular plugging. The basal cell layer was intact without vacuolation. The dermis appeared homogenous and little oedematous []. There was patchy periappendageal inflammation and subcutaneous fat layer showed patchy septal inflammation with lymphocytic infiltrates. The histopathology was consistent with morphoea.\nThe patient was started on twice daily topical Tacrolimus 0.1% ointment. The lesions were less obvious after 1 month of starting the therapy though there was no change in the cutaneous atrophy component.