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July 2011

Perifollicular Papules and Hyperkeratotic Plaques on the Back in a Blaschkoid Distribution —Diagnosis

Arch Dermatol. 2011;147(7):857-862. doi:10.1001/archdermatol.2011.165-b

Histopathologic examination of the specimen revealed abundant sclerosis of the reticular dermis and septa of the subcutis as well as sclerosis of the papillary dermis with edema, thinning of the epidermis, hyperkeratosis, and follicular plugging. A small perivascular and interstitial lymphocytic infiltrate was present. The histopathologic findings were consistent with morphea with features of LS.

Morphea, or localized scleroderma, is an inflammatory disease characterized by excessive collagen deposition leading to thickening of the dermis and subcutaneous fat. Classically, morphea begins as a slightly elevated, erythematous to violaceous edematous plaque that transforms into sclerotic scarlike tissue that can acquire a shiny white color.1 Lichen sclerosus et atrophicus, also an inflammatory skin disease, is characterized by distinct scar formation that affects the epidermis and superficial dermis and most often involves genital mucosa, although extragenital reports are not uncommon. Lichen sclerosus et atrophicus lesions typically start out as polygonal bluish white, shiny, interfollicular papules that can coalesce into patches and eventually develop scarlike atrophy.1

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