Case Number : Case 1488- 08 March Posted By: Guest

Atrophic epidermis, hyperkeratosis, interface change, superficial sclerosis of the dermis with lymphocytic inflammatory infiltrate under the sclerosis. Lichen sclerosus.

Let me bring to the differential lupus erythematosus, I think there is a hint of mucin on the dermis

Hello! Happy Women's Day...Also favor Lichen Sclerosus et Atrophicus

Agree with the differentials. Favour LSet A. Would add morphoea (early phase) to the list.

Favor Lichen sclerosis et atrophicus

?Tick bites.  ?Acrodermatitis chronica atrophicans.  Like Mona, I think the history does not fit with LS. 

Agree with LSA.

Yes ...the history doesn't fit! Acrodermatitis chronic atrophicans fit, but pathologically the intradermal inflammatory infiltrate isn't usually under a sclerotic papillary dermis...However like the suggestion of Abdul.

Interestingly, when the patient was seen by an experienced dermatologist, she had small pinkish grouped papules that involved the trunk and arms; many were umbilicated and some had depressed centers. Others were the classic ‘porcelain white’ lesions with an erythematous border. The dermatologist was quite concerned about malignant atrophic papulosis (Degos' disease) and we suggested that the histology fit this diagnosis in this clinical context. The patient recently had a full work up and appears to have skin limited disease. 

Great case. Dr. Sundram was there any evidence of mucin deposition in the biopsy?

Histology looks typical / diagnostic of lichen sclerosus - I still prefer LS histologicaly even if this differs from the favoured clinical diagnosis.