PMC9110700_01
(A) Whitish indurated plaques with slight erythematous border consistent with localized scleroderma; (B) detail of the patient's trunk, where a whitish indurated lesion could be observed; (C) erythema and scarring around the anogenital area of the patient consistent with lichen sclerosus.
fimmu-13-887279-g001.jpg
PMC9110700_01_fimmu-13-887279-g001.jpg
f1
Physical examination demonstrated multiple whitish indurated plaques distributed at the trunk, upper and lower limbs, as well as at the genitalia, consistent with the patient's history of LoS and LiS ( Figures 1A-C ).
(A, B) Erosions superimposed on whitish plaques with atrophic epidermis at the right and left upper limbs.
fimmu-13-887279-g002.jpg
PMC9110700_01_fimmu-13-887279-g002.jpg
f2
Examination of the forearms demonstrated confluent erosions superimposed on skin areas affected by LoS and LiS lesions ( Figures 2A, B ).
A skin biopsy from an indurated plaque of the trunk showing (A) epidermal atrophy and (B) thickened collagenous bundles in the reticular dermis (H&E). Direct immunofluorescence taken from the skin near to an erosion of the upper limb showed linear deposition of IgG (C) and C3 (D), consistent with a diagnosis of BP; (E) indirect immunofluorescence of human salt-split-skin showing IgG deposition along the epidermal side of the basement membrane zone.
fimmu-13-887279-g003.jpg
PMC9110700_01_fimmu-13-887279-g003.jpg
f3
A skin biopsy was later obtained from an indurated plaque of the trunk, revealing findings consistent with LoS ( Figures 3A, B ). Indirect immunofluorescence (IIF) on salt-split-skin (SSS) showed a linear deposition of IgG autoantibodies along the epidermal-BMZ ( Figure 3E ).
(A, B) Significant improvement of the lesions after the introduction of systemic steroids with complete resolution of the erosions after 4 months of treatment.
fimmu-13-887279-g004.jpg
PMC9110700_01_fimmu-13-887279-g004.jpg
f4
After a 4-month follow-up, erosions completely healed, and pruritus disappeared ( Figures 4A, B ).