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.