Case report
A 67-year-old woman referred to dermatology ward. She had positive history of hypertension, hyperlipidemia and eczema due to pruritus and blistering lesions on the anterior trunk and inguinal area since four months prior to being admitted. Clinical examination revealed generalized skin dryness, erythematous, slightly indurated plaques containing bullae on the anterior trunk and inguinal area, dull erythematous and sclerotic plaques on both legs (Figure 1,2). Two punch biopsies were taken from the trunk and leg. Microscopic examination of the trunk lesion showed hyperkeratosis, thinning of epidermis, edema of papillary dermis with focal subepidermal bulla containing RBCs, focal mild lymphocytic infiltrate in the mid and deep dermis and homogenization of collagen fibers of the reticular dermis. Microscopic examination of leg lesion showed hyperkeratosis, mild thinning of epidermis, homogenization of collagen fibers, mild perivascular and focal interstitial lymphocytic infiltrate in the superficial and deep dermis. According to the mentioned histopathologic report, simultaneous features of both bullous LSA and morphea was seen in the same lesion of trunk and features of morphea alone was seen on the leg lesions (Figure 3,4). Methotrexate 7.5 mg orally was prescribed. Due to incomplete response pulse of methylprednisolone 250 mg intravenously in 3 consecutive days was added. Both types of lesions were treated successfully.