Kumar Piyush, Jha Abhijeet Kumar, Mallik Sambeet Kumar, Raihan Mohammed
Skinmed. 2014 Mar-Apr;12(2):123-5.
A 35-year-old man presented with asymptomatic eruption on both forearms and lower aspects of the legs for 6 months. The lesions first appeared on his inner aspects of the wrist, the dorsal surface of the hands, and legs and progressed to involve proximal aspects of the extremities. There was no significant past history. On examination, multiple pearly white papules and depigmented atrophic plaques were found bilaterally on the flexors of the arms and the extensors of the legs. The lesions were arranged in a linear manner, following the lines of Blaschko (Figures 1 and 2). The surface of the atrophic plaques was notable for prominent telangiectasia, giving an erythematous appearance. The genitalia, oral cavity, palms, and soles were spared. Systemic examination was noncontributory. Lichen striatus and extragenital lichen sclerosus (ELS) were considered the differential diagnosis. Clinically, the age of the patient, the absence of scaling, and the presence of atrophic plaques and telangiectasia were in favor of ELS. A punch biopsy from an atrophic plaque was performed, and it revealed hyperkeratosis, atrophic epidermis, basal layer vacuolar degeneration, mild lymphocytic infiltration in the dermis, edema, and homogenization of collagen of the upper portion of the dermis (Figures 3 and Figure 4). Histopathologic findings were consistent with lichen sclerosus. A diagnosis of bilateral zosteriform ELS was made.
一名35岁男性因双侧前臂和小腿下段出现无症状皮疹6个月前来就诊。皮疹最初出现在手腕内侧、手背和腿部，随后发展至累及四肢近端。既往史无特殊。体格检查发现双侧手臂屈侧和腿部伸侧有多个珍珠白色丘疹及色素脱失性萎缩斑块。皮疹沿Blaschko线呈线状排列（图1和图2）。萎缩斑块表面可见明显的毛细血管扩张，呈红斑样外观。生殖器、口腔、手掌和足底未受累。全身检查无异常发现。线状苔藓和生殖器外硬化性苔藓（ELS）被列为鉴别诊断。临床上，患者的年龄、无鳞屑、存在萎缩斑块及毛细血管扩张均支持ELS的诊断。对一块萎缩斑块进行了打孔活检，结果显示有角化过度、表皮萎缩、基底层空泡变性、真皮轻度淋巴细胞浸润、水肿以及真皮上部胶原均质化（图3和图4）。组织病理学结果符合硬化性苔藓。诊断为双侧带状疱疹样ELS。
