Morphea-like Lichen Sclerosus: Two Case Reports And Literature Review

Background: Morphea is a kind of localized scleroderma, classified as guttatemorphea, plaque-like morphea, linear scleroderma, and generalized morphea. Lichensclerosus (LS) is a chronic, inflammatory mucocutaneous disease. The aetiology of LSand morphea are all uncertain, but there are evidences to suggest that activation andimbalance of immunal system, autoimmune, infection, collagen metabolic abnormalities,etc. might be involved. There are conflicts concerning ascription of these two diseases.Some Scholars consider LSA as a subset of morphea, others believe them to be twomanifestations of the same disease. Still others believe there are enough clinical andhistological differences between LSA and morphea to accept that they are distinctdiseases.Case presentation: Case1: A61-year-old female presented with universal patchyrashes on her trunk for4years, an opalescent plaque in vulva for3years. Biopsyspecimens from the vulva and chest showed hyperkeratosis in epidermis, vacuolardegeneration in basal layer, edema and homogenization of the collagen in the upperdermis, indicating the diagnosis of generalized lichen sclerosis. The patient also sufferedfrom hypothyroidism and multi-systemic chronic inflammatory diseases in her pasthistory. Case2: A39-year-old female came to our hospital presented with porcelainwhite plaque on her back for1year, near which a wax yellow smaller plaque was seen.Biopsy specimens of the wax yellow plaque showed that collagen fibers of the wholedermis became thicker and lymphocytes infiltrated around vessels. Biopsy specimens ofthe porcelain white plaque showed atrophy in epidermis, hyperkeratosis in epidermis, flatted trochanterellus, vacuolar degeneration in basal layer, edema and homogenizationof the upper dermis, inflammatory cells in dermis, indicating the diagnosis of ichensclerosis.Conclusion: Both of the two LS patients have the features of morphea. LS andmorphea have similar etiology and pathogenic progresses. So we speculate that the twodiseases may be in the same spectrum. The systematic symptoms of LSA have beenrarely reported in the previous literatures. The patient of Case1had swollen, painfulfinger joints for several years, chronic atrophic gastritis, inflammation of the rectum andsigmoid, pneumonia, trigeminal neuralgia, Raynaud’s phenomenon (+) and so on. Ingeneralized LSA, joints, organs and nerve system may also be involved. In addition, thepatient in case1had a Hashimoto’s thyroiditis. There is an increased incidence oftissue-specific antibodies and associations with other autoimmune diseases in patientswith LS. Therefore, in our clinical diagnosis and treatment, once a patient is diagnosedas LS, he/she should be carefully checked whether there are some other immunologicdisorders in the patient.