Skin-nontumor / Clinical Dermatology - Lichen sclerosus et atrophicus

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Skin-nontumor / Clinical Dermatology

Other dermatoses

Lichen sclerosus et atrophicus

Reviewer: Mowafak Hamodat, MB.CH.B, MSc., FRCPC (see Reviewers page)
Revised: 26 August 2011, last major update August 2011
Copyright: (c) 2002-2011, PathologyOutlines.com, Inc.

Clinical features
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● Atrophic, hypopigmented patches or plaques, usually affecting the upper trunk, neck, flexor wrist or anogenital region
● Often women near menopause
● Cause unknown, but associated with HLA DQ7 and autoimmune disorders
● Has been described at areas of scars and at sites of radiotherapy
● In girls, may start at an early age with hemorrhagic perianal lesions; associated with constipation; may be mistaken for sexual abuse
● LS may co-exist with lichen planus and morphea or resemble lichen planus (Case Rep Dermatol 2010;2:55)
● Balanitis xerotica obliterans: involvement of glans penis
● Kraurosis: vulvar involvement; important complication is dysplasia / squamous cell carcinoma

Clinical description
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● Atrophic, hypopigmented patches or plaques

Micro description
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● Orthokeratotic hyperkeratosis, epidermal atrophy, hydropic degeneration of basal layer, replacement of papillary dermis by edematous, hypocellular, faintly staining band with chronic inflammatory infiltrate
● Early lesions may have lichenoid changes
● Late lesions may have hyalinization

Micro images
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Thinned epidermis with superficial dermal collagen homogenization

Virtual slides
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Lichen sclerosus et atrophicus

Differential diagnosis
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● Localized scleroderma (morphea)
● Lichen planus: lacks psoriasiform lichenoid pattern, epidermotropism affecting the basal cell layer, basement membrane thickening, foci of epidermal atrophy, and loss of papillary elastic fibers

End of Skin-nontumor / Clinical Dermatology > Other dermatoses > Lichen sclerosus et atrophicus

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