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).