- Email: [email protected]
Genital purpura as the presenting sign of lichen sclerosus
JAAD ONLINE: CLINICAL
PEARL
Genital purpura as the presenting sign of lichen sclerosus Matthew Lewis, MD, and Mary Gail Mercurio, MD Rochester, New York
CLINICAL CHALLENGE Early diagnosis of genital lichen sclerosus is challenging as the hallmark white, shiny, often atrophic plaques may not evolve until later in the disease course. Timely diagnosis and treatment of genital lichen sclerosus is paramount to prevent scarring, functional impairment, and dyspareunia.
SOLUTION Two patients presented for evaluation of asymptomatic genital purpura (Figs 1 and 2). Biopsy specimens revealed supportive histopathology of lichen sclerosus. Early histopathologic changes in lichen sclerosus show deterioration of papillary dermal collagen and ectatic vessels within the dermal papillae immediately beneath the basement membrane.1 These changes result in vulnerable superficial vasculature, which may hemorrhage with minor trauma. Thus, genital purpura may be the forme fruste of lichen sclerosus.
Fig 1. Lichen sclerosis. The right labia minora revealed a 4- 3 6-mm, well-demarcated, irregularly bordered, purple, nontender, nonblanching macule.
From the University of Rochester Medical Center, Strong Memorial Hospital. Funding sources: None. Conflicts of interest: None declared. Reprints not available from the authors. Correspondence to: Mary Gail Mercurio, MD, University of Rochester Medical Center, 601 Elmwood Ave, Box 697, Rochester, NY 14642. E-mail: [email protected].
J Am Acad Dermatol 2016;74:e97-8. 0190-9622/$36.00 Ó 2015 by the American Academy of Dermatology, Inc. http://dx.doi.org/10.1016/j.jaad.2015.12.005
e97
e98 Lewis and Mercurio
J AM ACAD DERMATOL
Fig 2. Lichen sclerosis. The ventral glans penis showed scattered 3- to 4-mm deep red, welldemarcated, irregularly bordered, nonblanching macules coalescing into a larger ecchymotic patch. The left glans penis revealed an ill-defined, smooth, white, 1-cm patch, adjacent to a patent urethral meatus. There was obliteration of the coronal sulcus.
REFERENCE 1. Regauer S, Liegl B, Reich O. Early vulvar lichen sclerosus: a histopathological challenge. Histopathology. 2005;47:340-347.
MAY 2016
PEARL
Genital purpura as the presenting sign of lichen sclerosus Matthew Lewis, MD, and Mary Gail Mercurio, MD Rochester, New York
CLINICAL CHALLENGE Early diagnosis of genital lichen sclerosus is challenging as the hallmark white, shiny, often atrophic plaques may not evolve until later in the disease course. Timely diagnosis and treatment of genital lichen sclerosus is paramount to prevent scarring, functional impairment, and dyspareunia.
SOLUTION Two patients presented for evaluation of asymptomatic genital purpura (Figs 1 and 2). Biopsy specimens revealed supportive histopathology of lichen sclerosus. Early histopathologic changes in lichen sclerosus show deterioration of papillary dermal collagen and ectatic vessels within the dermal papillae immediately beneath the basement membrane.1 These changes result in vulnerable superficial vasculature, which may hemorrhage with minor trauma. Thus, genital purpura may be the forme fruste of lichen sclerosus.
Fig 1. Lichen sclerosis. The right labia minora revealed a 4- 3 6-mm, well-demarcated, irregularly bordered, purple, nontender, nonblanching macule.
From the University of Rochester Medical Center, Strong Memorial Hospital. Funding sources: None. Conflicts of interest: None declared. Reprints not available from the authors. Correspondence to: Mary Gail Mercurio, MD, University of Rochester Medical Center, 601 Elmwood Ave, Box 697, Rochester, NY 14642. E-mail: [email protected].
J Am Acad Dermatol 2016;74:e97-8. 0190-9622/$36.00 Ó 2015 by the American Academy of Dermatology, Inc. http://dx.doi.org/10.1016/j.jaad.2015.12.005
e97
e98 Lewis and Mercurio
J AM ACAD DERMATOL
Fig 2. Lichen sclerosis. The ventral glans penis showed scattered 3- to 4-mm deep red, welldemarcated, irregularly bordered, nonblanching macules coalescing into a larger ecchymotic patch. The left glans penis revealed an ill-defined, smooth, white, 1-cm patch, adjacent to a patent urethral meatus. There was obliteration of the coronal sulcus.
REFERENCE 1. Regauer S, Liegl B, Reich O. Early vulvar lichen sclerosus: a histopathological challenge. Histopathology. 2005;47:340-347.
MAY 2016