Nerve alterations showing autophagy in 2 patients with lichen aureus

Lichen aureus is a rare, chronic, persistent purpuric dermatosis clinically characterized by striking yellow- to bronze-colored lesions. Histologically, lichen aureus differs from other pigmented purpuric dermatoses in containing dense, band-like infiltrates closely associated with the epidermis. This report describes 2 patients with lichen aureus, a 20-year-old woman with a lesion on her right arm and a 51-year-old man with a lesion on the right side of his groin. Skin biopsy specimens revealed almost identical findings in both patients, including dense band-like infiltrates containing lymphocytes, histiocytes with hemosiderin deposits scattered extravasated red blood cells and nerve alterations at the dermo-epidermal interface. The nerves within the lesions were filled with granules, which stained positive with antibody to microtubule-associated protein 1A/1B-light chain 3, suggesting autophagy within the nerves. These altered nerves were present only in areas of band-like dermal lymphocytic infiltration. Electron microscopy of the lesions showed the accumulation of autophagosomes in Schwann cells.