Hemorrhagic Bullous Lichen Sclerosus of the Breast: A Rare Complication of Radiotherapy

Cutaneous side effects from radiotherapy are commonly reported in breast cancer patients. Radiation-induced hemorrhagic bullous lichen sclerosus (RHBLS) of the breast is a rare, but important, complication of radiotherapy. RHBLS typically presents as painful, hemorrhagic bullae with surrounding sclerotic tissue. A 71-year-old female with a history of whole breast radiotherapy for invasive ductal carcinoma of the right breast and ductal carcinoma in situ (DCIS) of the left breast presented to the clinic with pruritic, firm, and erythematous plaques involving the inframammary folds that progressed into large, painful, hemorrhagic bullae surrounded by porcelain-white skin over several weeks. Biopsy was consistent with RHBLS. She was initially treated with systemic steroids and Clobetasol 0.05% ointment twice daily with partial improvement. To the best of our knowledge, only three definitive cases have been previously reported in the literature making this the fourth case.