Disseminated lichen sclerosus of the trunk and upper extremities

A 41-year-old Japanese woman presented with a 4-year history of multiple white atrophic plaques. The lesions had occurred on the right upper arm as white papules of 2-3 mm in diameter, which had gradually become enlarged and spread to the right upper back and the neck. Physical examination revealed that the lesion on the right upper back was accompanied by erythema and erosions. Similar lesions were observed on the neck, chest, right forearm, and genital area. Dermoscopically, each lesion mainly consisted of a "whitish patch" and follicular pigmentation. No obvious "comedo-like opening" was noted. Histopathologic examination revealed atrophic epidermis, hyperkeratosis in the horny layer, edematous stroma, and homogenous collagenous tissue in the upper dermis. On the basis of these findings, a diagnosis of multiple lichen sclerosus was made. We started treatment with topical betamethasone butyrate propionate ointment (Antebate^® ointment, 0.05%) for 2 weeks, followed by treatment with topical tacrolimus ointment (Protopic^® ointment, 0.1%). The erosions and pain in the plaques disappeared after 6 weeks. In the current case, it is of interest that topical tacrolimus ointment was effective for extragenital lichen sclerosus. Dermoscopy may be useful to assist with diagnosis, but we should bear in mind that the dermoscopic findings of lichen sclerosus vary by the stage and location of the lesions.