Skin-nontumor / Clinical dermatology
Other dermatoses
Lichen sclerosus et atrophicus

Author: Mowafak Hamodat, M.D., MB.CH.B, MSc., FRCPC (see Authors page)

Revised: 1 July 2016, last major update August 2011

Copyright: (c) 2002-2016, PathologyOutlines.com, Inc.

PubMed Search: Lichen sclerosus et atrophicus [title]

Etiology
  • 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 Features
  • Atrophic, hypopigmented patches or plaques
Micro Description
  • 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

Images hosted on other servers:

Thinned epidermis with superficial dermal collagen homogenization

Differential Diagnosis
  • 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