Case Number : Case 2796- 25 March 2021 Posted By: Saleem Taibjee

I wonder if this is the early inflammatory phase of a lesion of extra-genital lichen sclerosus.

I entirely agree with you Richard about your suggestion of extra-genital LS, the haemorrhagic plaque with eminent blistery surface clinically complete the picture when correlated with the histology. 

Was this patient on any anti-coagulants or anti-platelets? the mechanism of upper dermal haemorrhage is not clear in such cases and not all the them are on those medication. If anybody know, it will be useful to educate us.

Bullous and haemorrhagic lichen sclerosus

bullous LSA

Agree. 

Yes, this is haemorrhagic / purpuric / bullous extragenital lichen sclerosus. It is always a good feeling to come up with a histological diagnosis which was completely unsuspected by the clinician! When we scrutinise the clinical images with the benefit of hindsight, we can appreciate some subtle white sclerotic change above the haemorrhagic area. As far as know, the patient does not have any predisposition to haemorrhage, anticoagulants, etc. This phenomenon is presumably directly related to the dermal and vascular fragility caused by LS. I have not previously come across such a striking haemorrhagic example in an extragenital location. As we know, haemorrhagic changes are not so uncommon in vulval LS, and indeed have led to concerns of sexual abuse in some cases.