Hemorrhagic Bullous Lichen Sclerosus: A Case Report

BACKGROUND Lichen sclerosus (LS) is a chronic autoimmune dermatosis characterized by white, sclerotic, atrophic plaques. Classic LS commonly occurs in the anogenital region, while extragenital lichen sclerosis typically occurs on the trunk and proximal extremities. Bullous lichen sclerosus is a rare variant that can occur in both genital and extragenital LS. Flaccid bullae can form, which may become hemorrhagic and produce a characteristic appearance clinically. CASE REPORT In this report, we describe the case of a 63-year-old female patient who presented for evaluation of a rapidly growing, erythematous, scaly growth on her back/shoulder that was biopsied and found to be hemorrhagic bullous LS. We will discuss the clinical and histologic features of this case as well as treatment of bullous LS, which in this case was a topical high-potency corticosteroid. CONCLUSIONS Bullous LS has been poorly studied due to the rarity of the condition, with limited investigation of the clinical and histopathologic characteristics of bullous LS and the available treatment options. Although rare, extragenital LS with hemorrhagic bullous features is an important variant of LS that should be considered to ensure appropriate diagnosis and treatment.