Discussion
Our patient was presented with sclerotic plaques on her trunk and lower extremities with coexistence of bulla on the sclerotic plaques on the trunk with diagnosis of concurrent bullous LSA and morphea in the same lesion.
Simultaneous bullous LSA and morphea is a very rare disease. Morphea and LSA can coexist in a same patient and in spite of different clinical and histomorphological presentations, simultaneous occurrence of both conditions in a single lesion indicates overlapping similar possible etiopathogenesis (1).
However, it is not very clear as to why bullous morphea and LSA coexist. This close relationship raises the question of whether morphea and LSA are different manifestations of the same disease (2).
Abhijit Das and his colleagues reported a 4-year-old girl presented with a nonpruritic hypopigmented sclerotic patch over her left shoulder that histopathological examination showed features consistent with both LSA and morphea in the same lesion (1).
Sirin Yasar reported a 70-year-old man presented with annular, ivory colored, atrophic plaques, surrounded by erythema on his trunk with occasional bulla formation on the plaques for 6 months. Histopathologic examination was consistent with bullous morphea and LSA (2).Bullous morphea usually characterized with bullae on or around atrophic morphea plaques .Cllinicaly, bullous morphea may resemble Bullous Lichen sclerosus and the clinical setting is insufficient to make the diagnosis. However, they are differentiated by histological examination and only bullous LSA shows hyperkeratosis, follicular plugging, or epidermal atrophy with vacuolar change of basal cells, which were seen in our case.
Another study by Ardian cuellar-barboza described a 56-year-old woman with progressive bullous sclerotic lesions diagnosed as bullous morphea (6).
Can Baykal reported a 74-year-old woman with a 6-month history of multiple asymptomatic, shiny, indurated plaques located on her abdomen and back with diagnosis of morphea-LSA overlap (5).