Extensive bullous lichen sclerosus et atrophicus

Vukičević, Jelica

doi:10.1590/abd1806-4841.20164398

Cited by 9 publications

(12 citation statements)

References 10 publications

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“…This feature is also closely associated with marked papillary dermal edema and even with subepidermal vesiculation and hemorrhage. Although the etiology of bullous LSA is unknown, loss of androgen receptor expression, random inactivation of the androgen receptor gene, autoimmunity with type II diabetes mellitus, and Borrelia infection are considered possible causes [1,2]. The extragenital form of LSA occurs in approximately 20% of the patients, and the isolated extragenital lichen sclerosus being even rarer tends to develop unusual clinical presentation, such as the development of vesiculobullous lesions [3].…”

Section: Discussion Pathogenesismentioning

confidence: 99%

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Dermal Hemorrhage: A Clue to Lichen Sclerosus et Atrophicus

Phan

Sou

Sannaa

et al. 2020

Cureus

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Lichen sclerosus et atrophicus (LSA) may present in a rare bullous and hemorrhagic form that is often difficult to recognize both clinically and histopathologically. Clinically, the lesions may be characterized by atrophic and ivory-white sclerotic plaques in both genital and extragenital regions. Histologically, fully developed lesions of LSA are characterized by a thinned, effaced epidermis with interface change, a wide band of hyalinization in the upper dermis, and a lymphohistiocytic infiltrate below the hyalinized area. Extensive vacuolar degeneration weakens the integrity of the dermoepidermal junction, which contributes to the development of marked edema in the papillary dermis and subepidermal vesiculation. With increased fragility of dermal capillaries, hemorrhage can accumulate within the bullae. Recognizing prominent upper dermal hemorrhage as a secondary change may lead to a prompt diagnosis of LSA. We present a case of extragenital LSA that mimics a dermal hemorrhage clinically and histologically in a 71-year-old Caucasian woman.

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Section: Discussion Pathogenesismentioning

confidence: 99%

“…Extensive vacuolar degeneration weakens the integrity of the dermoepidermal junction, which contributes to the development of marked edema in the papillary dermis and subepidermal vesiculation. With increased fragility of dermal capillaries, hemorrhage can accumulate within the bullae [1].…”

Section: Introductionmentioning

confidence: 99%

Dermal Hemorrhage: A Clue to Lichen Sclerosus et Atrophicus

Phan

Sou

Sannaa

et al. 2020

Cureus

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“…Extragenital bullous LS can also be localized or generalized. Although the cause is unknown, possible theories include genetic predilection, hormonal abnormalities, autoimmunity and Borrelia infection …”

Section: Discussionmentioning

confidence: 99%

An intertriginous blistering eruption

et al. 2019

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A 66-year-old man presented with a 10-month history of erythematous blistering lesions in his axillae and groin. This eruption had begun when he was on holiday in the Caribbean, where he developed purpuric patches in the intertriginous areas. These then blistered within hours, leaving 'tissue paper-like' skin. The lesions were otherwise asymptomatic. His only longterm medication was co-tenidone for hypertension. He had no prior history of photosensitivity, excess alcohol intake, liver or autoimmune disease, or any relevant family history.On physical examination, macerated erythematous blistered areas were seen in the groin and axillae, with signs of atrophic wrinkled skin in the perinatal cleft, back and posterior legs. Nikolsky sign was negative ( Fig. 1a-d). There were no clinical changes noted on the oral and genital mucosae. The hair and nails were normal. Swabs, fungal cultures and Borrelia serology were negative. Figure 2 (a) Skin biopsy from affected skin of the patient showing hyperkeratosis, focal interface change and a subepidermal split. (b,c) Dermal hyalinization with subjacent perivascular lymphoid infiltrate. Haematoxylin and eosin; original magnification (a) 9 20; (b) 9 200; (c) 9 400. Clinicopathological case ª

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“…Evidence for the use of hydroxychloroquine in lichen sclerosis is largely anecdotal. Among three reported cases of bullous lichen sclerosus et atrophicus treated with hydroxychloroquine, two were unresponsive and one showed a positive response …”

Section: Clinical Applications In Dermatologymentioning

confidence: 99%

Hydroxychloroquine in dermatology: New perspectives on an old drug

et al. 2019

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Hydroxychloroquine is an age-old drug whose use as an immunomodulatory agent with a low side-effect profile continues to expand. We present a review of this drug including recently updated prescribing recommendations and a summary of its clinical application in dermatology. A maximum daily dose of 5.0 mg/kg based on actual body weight and no greater than 400 mg is advised in order to reduce the risk of retinopathy, which is potentially permanent and has an estimated prevalence of 7.5% at 5 years on standard dosing. Baseline ophthalmologic assessment followed by annual screening after 5 years is recommended; however, closer monitoring should be considered in the setting of existing retinopathy, a cumulative dose > 1000 g or renal dysfunction. Hydroxychloroquine is now considered to be safe in pregnancy, and routine glucose-6-phosphate dehydrogenase (G6PD) deficiency testing is not required. Smoking can significantly decrease its efficacy although the reason is still uncertain. Hydroxychloroquine appears to also demonstrate antineoplastic and cardioprotective benefits.

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Extensive bullous lichen sclerosus et atrophicus

Cited by 9 publications

References 10 publications

Dermal Hemorrhage: A Clue to Lichen Sclerosus et Atrophicus

Dermal Hemorrhage: A Clue to Lichen Sclerosus et Atrophicus

An intertriginous blistering eruption

Hydroxychloroquine in dermatology: New perspectives on an old drug

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