case_images: PMC9110700_01
case_images: (A) Whitish indurated plaques with slight erythematous border consistent with localized scleroderma; (B) detail of the patient's trunk, where a whitish indurated lesion could be observed; (C) erythema and scarring around the anogenital area of the patient consistent with lichen sclerosus.
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case_images: Physical examination demonstrated multiple whitish indurated plaques distributed at the trunk, upper and lower limbs, as well as at the genitalia, consistent with the patient's history of LoS and LiS ( Figures 1A-C ).
case_images: (A, B) Erosions superimposed on whitish plaques with atrophic epidermis at the right and left upper limbs.
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case_images: f2
case_images: Examination of the forearms demonstrated confluent erosions superimposed on skin areas affected by LoS and LiS lesions ( Figures 2A, B ).
case_images: A skin biopsy from an indurated plaque of the trunk showing (A) epidermal atrophy and (B) thickened collagenous bundles in the reticular dermis (H&E). Direct immunofluorescence taken from the skin near to an erosion of the upper limb showed linear deposition of IgG (C) and C3 (D), consistent with a diagnosis of BP; (E) indirect immunofluorescence of human salt-split-skin showing IgG deposition along the epidermal side of the basement membrane zone.
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case_images: PMC9110700_01_fimmu-13-887279-g003.jpg
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case_images: A skin biopsy was later obtained from an indurated plaque of the trunk, revealing findings consistent with LoS ( Figures 3A, B ). Indirect immunofluorescence (IIF) on salt-split-skin (SSS) showed a linear deposition of IgG autoantibodies along the epidermal-BMZ ( Figure 3E ).
case_images: (A, B) Significant improvement of the lesions after the introduction of systemic steroids with complete resolution of the erosions after 4 months of treatment.
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case_images: f4
case_images: After a 4-month follow-up, erosions completely healed, and pruritus disappeared ( Figures 4A, B ).