Bullous and verrucous lichen sclerosus with autoantibodies against both desmoglein Dsg1 and Dsg3.

Dear Editor, The classical characterization of lichen sclerosus (LS) is pruritic, white, sclerotic, and atrophic plaques.1 However, clinical variants have been separately described as bullous, hemorrhagic, pigmented, and verrucous forms, which are rare.1 We present a patient with extragenital LS with bullous and verrucous forms; it was a challenging diagnosis. The differential diagnosis of hyperpigmented and verrucous eruption includes LS, pemphigus vegetans, chromoblastomycosis, tuberculosis verrucosa cutis, squamous cell carcinoma, mycosis fungoides, viral warts, and pyoderma gangrenosum. The first-line treatment for LS is topical corticosteroids.3 The patients, who have a contraindication for the use of corticosteroids or have failed therapy with ultrapotent corticosteroids, can choose the topical calcineurin inhibitors as an alternative treatment option.3 Patients with associated malignancy or scarring interfering with normal function should undergo surgery after the disease activity has ceased.2 Phototherapy and photodynamic therapy are the third-line therapies used in patients who are resistant to the aforementioned treatments.2 In general, extragenital LS is not as responsive as genital LS, so it may therefore present a therapeutic challenge.3 Footnotes 1 Conflict of interest: None. [Extracted from the article]