26312 Lichen sclerosus associated with morphea in a patient treated with adalimumab

Abstract

A 31-year old female with a history of Crohn disease that was well controlled on adalimumab presented with an asymptomatic 2 cm × 4 cm patch with central hypopigmentation, peripheral erythema, and fine overlying scale on her right lower back. Previous treatment with topical antifungals and topical steroids yielded no improvement. Dermoscopy revealed pronounced skin lines, yellowish-white keratotic follicular plugs, and scattered small foci of brown pigment. Biopsy demonstrated a square punch with homogenization of the papillary dermis, flattening of the rete ridges with epidermal atrophy, follicular plugging, dense hyperkeratosis, scattered pigment incontinence, and thick collagen bundles associated with a predominantly mid-dermal to deep perivascular and interstitial infiltrate composed of lymphocytes and plasma cells. With this presentation, the diagnosis of a lichen sclerosus et atrophicus and morphea overlap disorder was made. These entities can show significant histological overlap, but there are multiple reports of these diseases occurring concomitantly. There have also been reports of morphea associated with the use of adalimumab, which this patient had been using for 3 years previously. Dermoscopy has been used to describe and assist with the diagnosis of both of these conditions. Outstanding clinical, dermoscopy, and microscopic images will be presented.