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Bullous Hemorrhagic Lichen Sclerosus of the Breast

Michael Ryan, Dr. Seena Monjazeb, Dr. Lindy S Ross, Dr. Kathleen T Kroger

University of Texas Medical Branch


Lichen sclerosus (LS) is a chronic dermatologic condition characterized by atrophic, white or porcelain appearing plaques that can cause intense pruritus, discomfort, and soreness. Plaques are most commonly located in the anogenital region, with women affected six to ten times more frequently than men. There is a bimodal age distribution of LS in females in which it frequently affects both prepubescent children and postmenopausal women. Early in the disease LS has a short inflammatory phase that eventually progresses to chronic atrophy and scarring. LS can lead to dysuria, dyspareunia, pain with defecation, and loss of architecture based on the location and extent of involvement. Patients with LS are at increased risk for squamous cell carcinoma of the vulva or penis arising in or around LS. While LS typically presents in the genital area, up to 15-20% of cases can present in extragenital skin. An uncommon bullous hemorrhagic variant of LS has also been described in the literature and has been noted in both anogenital and extragenital regions. We present two cases of bullous hemorrhagic LS of the breast arising in a 66 and 77 year old woman. LS presenting in this manner is highly unusual with few other cases reported. In addition to the case presentations and discussion, we also review the literature and compile other published cases of bullous hemorrhagic LS of the breast.

References:

• Meffert JJ, Davis BM, Grimwood RE. Lichen sclerosus. Journal of the American Academy of Dermatology. 1995 Mar 1;32(3):393-416. • Powell JJ, Wojnarowska F. Lichen sclerosus. The Lancet. 1999 May 22;353(9166):1777-83. • Tasker GL, Wojnarowska F. Lichen sclerosus. Clinical and Experimental Dermatology: Clinical dermatology. 2003 Mar;28(2):128-33.

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