10.5826/dpc.1202a63
text/xml
2160-9381
1794
en
Siddharth Mani
https://creativecommons.org/licenses/by-nc/4.0
Dermatology Practical & Conceptual
dermoscopy
Dermoscopic keys in extragenital bullous haemorrhagic lichen sclerosus
Text.Serial.Journal
https://dpcj.org/index.php/dpc
Research Letter
2022-05-02
2021-05-17
2022-05-02
2022-05-24
e2022063
Dermatol Pract Concept
Siddharth Mani
2022/05/02
10.5826/dpc.1202a63
e2022063
Department of Dermatology, INHS Asvini, Near RC Church, Colaba, Mumbai, India
2160-9381
dermoscopy
en
e2022063
.Ankad BS, Beergouder SL. Dermoscopic patterns in lichen sclerosus: A report of three cases. Ind Dermatol Online J. 2015;6(3):237-240. DOI:10.4103/2229-5178.156450. PMID: 26009734. PMCID: PMC4439768.
Dermoscopic keys in extragenital bullous haemorrhagic lichen sclerosus
https://dpcj.org/index.php/dpc/article/download/1794/1590
              Dermoscopic Keys in Extragenital Bullous
                  Hemorrhagic Lichen Sclerosus
                                              Siddharth Mani, Bhavni Oberoi


Department of Dermatology, INHS Asvini, Near RC Church, Colaba, Mumbai, India



Key words: lichen sclerosus, hemorrhagic, dermoscopy, follicular plugs
Citation: Mani S, Oberoi B. Dermoscopic keys in extragenital bullous hemorrhagic lichen sclerosus.
Dermatol Pract Concept. 2022;12(2):e2022063. DOI: https://doi.org/10.5826/dpc.1202a63
Accepted: September 22, 2021; Published: April 2022
Copyright: ©2022 Mani et al. This is an open-access article distributed under the terms of the Creative Commons
Attribution-NonCommercial License (BY-NC-4.0), https://creativecommons.org/licenses/by-nc/4.0/, which permits unrestricted
noncommercial use, distribution, and reproduction in any medium, provided the original authors and source are credited.
Funding: None.
Competing interests: None.
Authorship: Both authors have contributed significantly to this publication
Corresponding author: Bhavni Oberoi, Department of Dermatology, INHS Asvini, Near RC Church, Colaba, Mumbai- 400005 India.
E-mail: bhavni.oberoi@gmail.com




Introduction                                                             white and hemorrhagic crusts, follicular plugs, and multi-
                                                                         colored diffuse hemorrhagic area with varying shades rang-
Lichen sclerosus (LS) is a chronic inflammatory dermatosis               ing from black to red, with black color representing old
characterized by leukoderma and scarring, predominantly                  hemorrhage and red color representing recent hemorrhage
affecting the genital skin. It may sometimes involveextragen-            (Figure 1B). Surrounding skin revealed atrophy with follicu-
ital areas. The suffix atrophicans is no longer used as a few            lar plugs (Figure 1C). Based on the clinical and dermoscopic
cases are associated with hypertrophy rather than atrophy.               examination, we considered hemorrhagic lichen sclerosus, ir-
Few atypical variants include bullous, hemorrhagic, pig-                 ritated seborrheic keratosis, Bowen disease, and discoid lupus
mented, verrucous, and keratotic forms. Herein, we report                erythematosus as our differential diagnoses. H
                                                                                                                      ­ istopathology
a case of extragenital bullous hemorrhagic lichen sclerosus              revealed follicular plugs, epidermal atrophy, subepidermal
with its dermoscopic features.                                           blister, and hyalinized compact collagen, which confirmed
                                                                         the case to be LS (Figure 1D).

Case Presentation
                                                                         Discussion
A 40-year-old male presented with a nine-month history of a
slow-growing asymptomatic raised lesion on his back asso-                The extragenital form of LS is less common, and the bullous
ciated with occasional bleeding episodes after casual trauma.            hemorrhagic form is very rare, with only a handful of cases
There was no history of similar lesions in the past or else-             in the literature. This form is generally associated with less
where on the body. Physical examination revealed a solitary,             pruritus and the absence of any malignancy, as seen in our
well-defined, 2.5 cm × 2.0 cm, non-tender, hemorrhagic bulla             patient as well. In our case, the lesion was present on the
with crusting in the center and atrophy in the surrounding               back, a site that has not been reported for this particular
area (Figure 1 A). Dermoscopy revealed superficial yellowish             variant. The formation of bullous lesions has been described



Research Letter | Dermatol Pract Concept. 2022;12(2):e2022063                                                                        1
      Figure 1. A. A solitary, well defined, 2.5 cm × 2.0 cm, non-tender, hemorrhagic bulla with crusting in the centre and atrophy in
      the surrounding area. B. Dermoscopic examination of lesion shows superficial yellowish white and hemorrhagic crusts, follic-
      ular plugs and multicolored diffuse hemorrhagic area with varying shades ranging from black to red (black color representing
      old hemorrhage and red color indicating recent hemorrhage). Blue color indicates marking for biopsy site. C. Dermoscopic
      examination of surrounding skin shows atrophy with follicular plugs. D. Skin biopsy showing presence of follicular plugs,
      epidermal atrophy, subepidermal blister and hyalinized compact collagen (H&E x 40).


in LS. A possible explanation for the formation of bulla and            components [2]. Our case had superficial yellowish white
hemorrhage could be the pronounced edema within the skin                and hemorrhagic crusts, a multicolored (black to red) hem-
that disrupts the capillaries collagen support, predisposing            orrhagic area, and a peripheral atrophic area with follicular
them to rupture with minimal trauma or damage [1].                      plugs. There was no vascular pattern which commensurates
                                                                        with the chronicity of the lesion. The patient was managed
                                                                        with topical corticosteroids with a good response. This case
Conclusions
                                                                        report helps establish the fact that follicular plugs which
Dermoscopy of extragenital LS has been described as white               have been reported in LS are seen in this rare variant also. In
structureless areas, follicular plugs, white chrysalis-like             addition, the dermoscopic features of the hemorrhagic area
structures, and variable vascular patterns being the essential          of LS, which have not been previously described, have been




2                                                                           Research Letter | Dermatol Pract Concept. 2022;12(2):e2022063
brought out. This report will enhance the existing repertoire          lesions. Arch Dermatol. 1999;135(1):81-86. DOI: 10.1001/arch-
of knowledge of dermoscopic features of LS which may aid               derm.135.1.81. PMID: 9935386.
                                                                    2. Ankad BS, Beergouder SL. Dermoscopic patterns in lichen
diagnosis in future and avoid invasive procedures.
                                                                       sclerosus: A report of three cases. Ind Dermatol Online J.
                                                                       2015;6(3):237-240. DOI:10.4103/2229-5178.156450. PMID:
References                                                             26009734. PMCID: PMC4439768.


 1. Gómez-Calcerrada, del Cerro Heredero M, Sanchez MH, Fernan-
    dez RS, de Eusebio Murillo E, Yus ES. Bullous and hemorrhagic




Research Letter | Dermatol Pract Concept. 2022;12(2):e2022063                                                                     3
