Diagnosis Of Lichen Sclerosus Research Articles

Иммуноморфологическая характеристика склероатрофического лихена в раннем и позднем периоде

Introduction. Lichen sclerosus is a chronic inflammatory disease of the skin and mucous membranes, combining degenerative changes in the epidermis and dermis. Histological examination is needed due to diverse nosologies with similar clinical manifestations. Early development stages of lichen sclerosus are characterized by nonspecific histological changes. However, some changes can serve as indicators for accurate diagnosis. Materials and methods. The diagnosis was confirmed by typical clinical manifestations, medical history, and laboratory abnormalities. Biopsy samples were taken from early-stage lesions and recent rash sites. The patients were divided into two groups: group 1 consisted of patients with clinical manifestations of the disease lasting less than one year and group 2 included the patients who had symptoms for more than two years. Serial paraffin sections were stained with hematoxylin and eosin as well as Van Gieson’s picric fuchsin. We performed immunohistochemical analysis using polyclonal antibodies against CD95 and monoclonal antibodies against CD31. We evaluated the findings of the immunohistochemical assay semi-quantitatively in each case for every marker. Morphometric analysis of microvessels was conducted, and the expression intensity was determined. Results. We identified new extended criteria for the differential diagnosis of lichen sclerosus including the disease duration (the presence and prevalence of rashes, erosions, presence or absence of cracks), evaluation of the microcirculatory involvement, determination of the percentage of vascular damage, and the assessment of the severity of endothelial changes. Conclusion. By means of morphological analysis, we determined the diagnostic criteria for early and late stages of lichen sclerosus. Our research results and literature data analysis showed that damaged vascular wall was the main and determining factor of lichen sclerosus pathogenesis. Keywords: lichen sclerosus, histological analysis, immunohistochemical analysis, diagnostic criteria, vascular damage

Lichen Sclerosus is a high-cost diagnosis, compounded by comorbid conditions

Lichen Sclerosus is a high-cost diagnosis, compounded by comorbid conditions

D2-40 and CK17 Immunohistochemistry as a Diagnostic Adjunct for HPV-Independent Squamous Lesions in the Vulva and Their Role in Defining Atypical Lichen Sclerosus.

Vulvar lichen sclerosus (LS) is a common, chronic inflammatory disorder with a subset of cases progressing to differentiated vulvar intraepithelial neoplasia (dVIN) and/or squamous cell carcinoma (SCC). Histopathologic diagnosis of LS and dVIN can be challenging, and it is difficult to predict the subset of LS cases that progress. Immunohistochemistry (IHC) may be a useful diagnostic aid in this setting. CK17 has been shown to be overexpressed in invasive SCC and dVIN, and less commonly in LS. Similar to CK17, D2-40 has been correlated with cutaneous SCC prognosis but has not been evaluated in vulvar lesions. We identified a total of 13 patients with HPV-independent vulvar SCC that had precursor LS or dVIN. CK17 and D2-40 IHC stain intensity and pattern was scored in foci of LS, dVIN, and SCC. An increase in basal layer D2-40 expression was observed with progression from LS to dVIN with strong and diffuse staining in SCC. CK17 maintained similar stain intensity among squamous lesions, but displayed different patterns of staining, with superficial staining in LS, suprabasal staining in dVIN, and diffuse staining in SCC. A subset of LS cases displayed an intermediate (suprabasal) CK17 IHC profile, wild-type p53 expression, and cytomorphologic and architectural features intermediate between LS and dVIN; we defined such cases as "atypical LS." We found that a panel of D2-40/CK17 can serve as a diagnostic adjunct to differentiate LS, dVIN, and invasive SCC. Additional studies with larger patient cohorts are needed to validate these findings and determine their prognostic significance.

Treatment algorithm for the comprehensive management of severe lichen sclerosus in boys based on the pathophysiology of the disease

It is estimated that approximately one out of 200 boys has the diagnosis of lichen sclerosus (LS), previously referred to as BXO (balanitis xerotica obliterans). Severe progressive disease is rare however, mismanagement of urethral tissues may contribute to progression of LS. The current literature regarding the management of severe lichen sclerosus was reviewed alongside our management of seven patients with ages ranging from six to ten years of age with severe lichen sclerosus who required surgical intervention. These patients were identified out of a busy pediatric practice that saw 5507 patients during the four-year span. Based on the pathophysiology of lichen sclerosus, urethral anatomy, and our management an algorithm was developed for medical and surgical management. All patients received initial medical treatment with topical steroids. Three patients underwent urethral mobilization and serial biopsy. One of these patients with severe disease required a second distal urethral mobilization. Three patients were treated with circumcision, and one is responding well to topical steroids after complex reconstruction. None developed postoperative urethral disease. Lichen sclerosus affects squamous epithelium but can extend to unaffected tissue if traumatized via the Koebner phenomenon. There are no randomized control trials for the management of the disease. Thus, appropriate early management with avoidance of urethral dilation or incision may prevent extension down the urethra that can lead to severe stricture disease. Several authors identified this as one of the worst forms of stricture diseases to manage. Based on the pathophysiology of the disease and our 4-year experience treating patients, we propose an algorithm for management of severe lichen sclerosus in boys. The diagnosis of lichen sclerosus in boys requires a high level of suspicion, and early biopsies should be obtained if suspected. If identified before circumcision or meatotomy, initial treatment should be medical. If the patient fails topical steroid therapy, circumcision and biopsy are the initial recommended surgical approach. Optimally, a biopsy with the first meatotomy establishes the diagnosis. If the disease persists, urethral mobilization may represent a curative treatment as it advances healthy urethra and allows complete removal of distal squamous epithelium instead of traumatic repeated dilations or incisions. This paper summarizes the available literature on the management of severe LS and provides a flow diagram based on the pathophysiology of the disease and our experience sever cases.

Urinary microbiome differences between lichen sclerosus induced and non-lichen sclerosus induced urethral stricture disease.

To describe differences in the urinary microbiome of patients with pathologically confirmed lichen sclerosus (LS) urethral stricture disease (USD) vs non-lichen sclerosus (non-LS) USD pre- and post-operatively. Patients were pre-operatively identified and prospectively followed, all underwent surgical repair and had tissue samples obtained to make a pathological diagnosis of LS. Pre- and post-operative urine samples were collected. Bacterial genomic DNA was extracted. Alpha and beta diversity measurements were calculated and compared. A zero-inflated negative binomial model was utilized to compare taxa abundances between disease status and surgery status. Urine samples were obtained from both cohorts, 69 samples in total: 36 samples were obtained pre-operatively and 33 samples were obtained post-operatively. Ten patients provided both a pre-operative and post-operative urine sample. Twenty-six patients had pathological evidence of LS and 33 patients did not. There was a statistically significant difference in alpha diversity between the pre-operative urine samples of patients with non-LS USD and LS USD, (p = 0.01). There was no significant difference in alpha diversity within post-operative urine samples between patients with non-LS USD and LS USD, (p = 0.1). A significant difference was observed in Weighed UniFrac distances with respect to disease and operative status, (p = 0.001 and 0.002). LS USD have significant alterations in diversity and differential abundance of urine microbiota compared to non-LS USD controls. These findings could be used to guide further investigations into the role of the urinary microbiome in LS USD pathogenesis, severity of presentation, and stricture recurrence.

Chi cerca trova: il lichen sclero-atrofico

The case of a 7-year-old girl presenting with several cutaneous hypopigmented patches is described. The diagnosis of lichen sclerosus was finally made based on the presence of the typical perivulvar ivory white atrophic lesions.

Efficacy of injecting hybrid cooperative complexes of hyaluronic acid for the treatment of vulvar lichen sclerosus: Apreliminary study.

Lichen sclerosus is a chronic relapsing inflammatory skin disease, which involves most commonly the anogenital region. The gold standard in treatment is ultra-potent topical steroids (clobetasol propionate): it aims at controlling the symptoms, stopping further scarring and distortion, and reducing the risk of cancer. The aim of this preliminary study is to evaluate the efficacy of injecting Hybrid Cooperative Complexes of Hyaluronic Acid (HCC) for the treatment of vulvar lichen sclerosus (VLS). Twenty female adult patients (range: 21-78years), aged over 18, with histopathological diagnosis of lichen sclerosus and good general conditions were enrolled. Patients underwent HCC infiltration every month, for 3 times. Patients were evaluated at baseline (T0) and after one (T1) and six months (T2) after treatment. During every visit, each patient was studied clinically and with videothermography. Itching, burning sensation, pain, and dyspareunia were reported by patients at T0, T1, and T2. The effectiveness of the treatment on patients' quality of life and sexual function was evaluated using the Dermatology Life Quality Index (DLQI) and the Female Sexual Function Index (FSFI) at T0 and at T2. The results of this preliminary study are very promising, in fact, all patients had a significant reduction in most symptoms after 1 and 6months of HCC treatment. The reduction of patients with itching (p value ≤ 0.001), pain (p value=0.031), and burning sensation (p=0.004) at 6months is significant. The analysis of DLQI scores revealed a significant improvement in patients' quality of life. At baseline, the average score of DLQI (±SD)was 5.89±3.68 while at follow-up it was 3.42±2.36 (p=0.002). Our preliminary study has demonstrated the validity and tolerability of HCC infiltrations in patients with VLS, and the effectiveness of HCC in reducing symptoms and, thus, to improve sexuality and patient quality of life.

Management of patients with the atrophic variant of vulvar lichen sclerosus

Aim.The objective is to optimize the diagnosis and management of the atrophic variant of the vulvar lichen sclerosus (LS).
 Materials and methods. We examined 58 female patients from 20 to 70 years old with the atrophic variant of the vulvar LS. The control group included 30 deemed healthy females 2070 years old. The atrophic variant of LS was diagnosed based on symptoms (dryness and discomfort in the vulva, superficial vulvodynia and dyspareunia, mild itching) and signs (marked atrophy of the external genitalia tissue up to aplasia of the labia minora and clitoris, vaginal stenosis, minimal hypopigmentation, absence of sclerosis). In addition, the following cytokines were measured in the peripheral blood of patients: interleukin (IL)-20, 23, 10, tumor necrosis factor-, and interferon-. The measurements were performed before and after immunotherapy with sodium deoxyribonucleate.
 Results. In all patients, there was a rapid shrinkage of the labia minora and clitoris, thinning and easy traumatization of the dermis and epidermis, contributing to secondary infection and synechiae formation up to complete vaginal occlusion. An increase in IL-23 (19.01 [18.0; 38.5] vs. 16.6 [12.98; 20.71] in the control group), 2.7-fold (p0.03) decrease in tumor necrosis factor-, interferon- and IL-20 are common for the atrophic variant of LS. The immunomodulatory and clinical efficacy of sodium deoxyribonucleate was demonstrated. Severe vulvodynia before treatment was noted in 29 (50%) patients and no patient (0%) after therapy; 44 (75.8%) patients reported complete reversal of superficial vulvodynia after treatment, and there were no patients without vulvodynia before treatment (0%). Mild itching before treatment was noted by 20 (40%) patients and 2 (3.4%) patients after treatment. Considering the cytokine levels, topical glucocorticoids in atrophic LS are inappropriate and can lead to atrophy and immunosuppression aggravation, contributing to the secondary infection.
 Conclusion. The observed differences in cytokine levels in patients with atrophic vulvar LS confirm the relevance of LS clinical classification by variants, support their use for LS diagnosis and immunotherapy efficacy control, and also suggest a differentiated approach to the treatment of different LS variants considering the effect of the drugs used on cytokine status.

Lichen Sclerosus throughout Childhood and Adolescence: Not Only a Premenarchal Disease

To determine the frequency of persistence of vulvar lichen sclerosus (LS) through the pubertal transition and assess if the symptomatology and exam findings differ by menarchal status at onset of symptoms DESIGN: A retrospective cohort study SETTING: Academic tertiary care hospital PARTICIPANTS: Females aged 21 years or younger with a diagnosis of vulvar LS INTERVENTION: None MAIN OUTCOME MEASURES: Menarchal status at symptom onset, presenting symptoms, exam findings, persistence after menarche RESULTS AND CONCLUSIONS: Of the 196 patients who met criteria, 141 were premenarchal and 55 postmenarchal. Of these 55, 36 had postmenarchal symptom onset, and the others had premenarchal symptom onset or LS diagnosis. Over the data review period, 26 patients were followed through the pubertal transition, and 10 (38.5%) had continued symptoms of LS. The premenarchal group (n=141) was significantly more likely than the symptom-onset postmenarchal group (n=36) to present with vulvar itching (70.2% vs 52.8%; P=.048), vulvar bleeding (26.2% vs 5.6%; P=.008), and bowel symptoms (16.3% vs 0%; P=.009). The premenarchal group was significantly more likely on exam to have subepithelial hemorrhages (24.8% vs 5.6%; P=.01). The postmenarchal group had more clitoral adhesions (25.0% vs 4.3%; P < .0001) and loss of labia minora (47.2% vs 2.1%; P < .0001). Thirteen postmenarchal patients presented with dyspareunia. This study suggests that premenarchal LS can persist after menarche in about 40% of adolescents and can initially develop in postmenarchal adolescents. Initial symptoms and exam findings differ on the basis of menarchal status. Continued surveillance is recommended.

Does treatment of lichen sclerosus improve overactive bladder symptoms?

Lichen sclerosus (LS) is a chronic disease which mainly affects the vulvar area in women. A few studies have shown a possible relationship between LS and overactive bladder (OAB) symptoms, but no studies have investigated whether OAB symptoms improve after initiating treatment of LS. The aim of this study was to investigate whether the treatment of LS also improves OAB symptoms in women newly diagnosed with LS. This was a prospective cohort pilot study based on questionnaires from women newly diagnosed with LS and with symptoms of OAB. Women above the age of 18 who were newly diagnosed with LS were included. The women completed two questionnaires on OAB at inclusion and after 3months. The questionnaires consisted of the validated questionnaires OAB-q (33 questions, maximum score 198) and ICIQ-OAB (8 questions, maximum score 56). All women initiated treatment with local steroid by the time of the LS diagnosis. A total of 40 women were included, and 13 women dropped out during the data collection time. Comparing month 0 to month 3 for the remaining 27 women, a mean difference at 28.8 points was observed for OAB-q and a mean difference of 5.7 points was observed for ICIQ-OAB. Both results showed a statistically significant difference after 3months (p < 0.05). A total of 92.6% (25/27) of the women improved their symptoms. Treatment with local steroid might improve OAB symptoms in women newly diagnosed with LS.

Dermoscopic Evaluation of Extragenital Lichen Sclerosus et Atrophicus.

IntroductionLichen sclerosus (LS), is an uncommon inflammatory dermatosis with preferential involvement of anogenital region. Diagnosis of LS is mainly clinical, but clinical differentiation from conditions like vitiligo, morphea may be a difficult task at times that often requires histological analysis. Dermoscopy is one such non-invasive tool which can help diagnose the disease. There is paucity of Indian data on dermoscopy of LS.ObjectivesTo evaluate clinical, dermatoscopic patterns of LS and correlate them with histopathology.MethodsThe study was conducted in a tertiary hospital after obtaining consent from 20 patients. OITEZ e-scope digital microscope was used to evaluate the lesions. Both polarized and nonpolarized mode were used and skin biopsy was done to confirm diagnosis.ResultsBased on morphology, LS was classified as scleroatrophic lesions (61.5%), guttate lesions (30.8%) and hyperkeratotic lesions (7.7%). Dermoscopic analysis revealed structureless white to yellow areas as most common finding (100%) followed by chrysalis like structure (80.8%). Linear irregular vessels were seen in 61.5% lesions and perifollicular scaling in 50.0% lesions. Keratotic plugs were seen in 50.0% lesions. A new characteristic finding, “rosettes” was seen in 38.5% lesions has never been reported with LS before. Non polarized mode was particularly useful for identifying texture changes, keratotic plugs and minute scales which were not visible otherwise.ConclusionsDermoscopy is a simple diagnostic tool that helps in the early diagnosis of LS with specific pattern which can avoid invasive procedure like biopsy. Both non-polarised and polarized dermoscopy must be done to visualize the changes of LS well.

Association of vulvar lichen sclerosus with endometrial and ovarian cancer

Association of vulvar lichen sclerosus with endometrial and ovarian cancer

Ink test: A useful technique to enhance extragenital lichen sclerosus diagnosis.

Lichen sclerosus (LS) is a rare and chronic autoimmune disease, and extragenital LS is particularly challenging to diagnose in children. Histopathology is the gold standard for diagnosis. Dermoscopy is a useful tool when follicular plugs (FP) are observed, though FP are sometimes hard to recognize. The ink test may provide a useful technique to enhance FP visualization and support a diagnosis of extragenital LS, thereby avoiding diagnostic delays or biopsy.

Comparison of lichen sclerosus in boys and girls: A systematic literature review of epidemiology, symptoms, genetic background, risk factors, treatment, and prognosis.

BackgroundStudies concerning pediatric lichen sclerosus are limited, and, to date, there have been no studies comparing the course of lichen sclerosus in boys and girls. We sought to examine all publications on boys and girls with lichen sclerosus and assess and compare epidemiology, symptoms and signs, genetic background, risk factors, treatment, and prognosis.MethodsA systematic search was performed in the Embase, Medline, Cochrane, and Web of Science databases. Inclusion criteria were information on children ages 0–18 years and a clinical or histologic diagnosis of lichen sclerosus. Literature from 1985 to 2021 was reviewed.ResultsA total of 1780 articles were retrieved from the search, of which 90 articles were eligible for inclusion. Boys and girls present similarly on many aspects; nonetheless, treatment and follow‐up are approached differently.ConclusionsThough the clinical approach is often different, lichen sclerosus in boys and girls demonstrates many similarities. More research is needed, especially on follow‐up, to gain a better understanding of the course of lichen sclerosus and establish an advanced management plan for children.

Lichen sclerosus in pediatric age: A new disease or unknown pathology? Experience of single centre and state of art in literature.

Lichen Sclerosus (LS) is a chronic inflammatory skin disease with unknown etiology. In pediatric age the main disease "lichenlinked" is the phimosis in male. This is a retrospective study that reports the experience of our clinic and review of the literature. We included all patients affected by pathological phimosis, treated by circumcision between January 2015 and May 2020, older than 6 years old and with an histopathological diagnosis of lichen sclerosus. The aim was to identify prognostic factors based on histological report to plan the clinical management of patients. Statistical analysis was done. We included 207 patients. The mean age of children was 9,78 years (5-18 years, DS±3.29). Based on the histological features we divided patients in 2 groups: early lesions (70/207, 34%) and advanced (137/207, 66%). In term of complications lichen linked we considered meatal stenosis that needed of urethral dilatations. We included 7 patients (7/207, 3,4%). We report P value Statistical Significance in many aspects. An early diagnosis of LS and surgical treatment of foreskin are essential to prevent early and late complications in children. The size of sample is a limit of the study but results encourage our management.

Influence of Photodynamic Therapy on Lichen Sclerosus with Neoplastic Background.

Background: Lichen sclerosus is the most common nonmalignant vulvar disease with morbidity in postmenopausal age. The first line of treatment is corticosteroid therapy. In case of insufficiency, tacrolimus or pimecrolimus can be provided. Photodynamic therapy (PDT) can be used as alternative way of treatment while symptoms recurrent despite other methods. Methods: the analyzed population of 182 women with diagnosis of lichen sclerosus treated using PDT was divided into three groups: patients with neoplastic disease or intraepithelial neoplasia; those with a positive family history of neoplastic disease; and a control group with no neoplastic disease and no familial history of neoplastic diseases. Results: Reduction of vulvar changes was assessed in the whole vulva in the groups as 21.9%, 21.2% and 21.8%, respectively. The most frequent symptom, itching, was reported to decrease in all groups, 39.3%, 35.5% and 42.5%, respectively. Improvement of quality of life was assessed in 91.3% of the whole group, stabilization of lichen sclerosus in 7.1% and progression in 1.6%. Conclusions: Photodynamic therapy gives positive results in most cases. Improvement after PDT is observed in objective vulvoscopic assessment and in subjective patients’ opinions. Neoplastic disease in the past can influence the effectiveness of PDT.

The efficacy of injecting hybrid cooperative complexes of hyaluronic acid for the treatment of vulvar lichen sclerosus: A preliminary study.

Lichen Sclerosus is a chronic-relapsing inflammatory skin disease usually involving the anogenital region lacking a resolutive therapy. Potent to high-potent topical corticosteroids are considered to be the standard first-line treatment. The objective of this preliminary study is to evaluate the efficacy of injecting Hybrid Cooperative Complexes of Hyaluronic Acid (HCC) in the treatment of Vulvar Lichen Sclerosus (VLS). Twenty-female patients (range 21-78 years) with histopathologic diagnosis of lichen sclerosus and good general conditions were enrolled. Patients underwent HCC infiltration every month, for three times. Patients had been assessed at baseline (T0) and after 1 and 6months from treatment (T1 and T2, respectively). Clinical evaluation was executed in every visit. Itching, burning sensation, pain and dyspareunia were reported by a patient at T0, T1, and at T2. The effectiveness of the treatment on patients' quality life and sexual life was assessed using the Dermatology Life Quality Index (DLQI) at T0 and at T2. During or after the treatment no complications or side-effects were observed. All patients had a significant reduction in most symptoms after 1 and 6months of HCC treatment. The reduction of patients with itching (p ≤ 0.001), pain (p=0.031), burning sensation (p=0.004) at 6months is significant. The analysis of DLQI scores revealed a significant improvement in patients' quality of life. The DLQI mean score (±SD) at baseline and at follow-up was 5.89 ± 3.68 and 3.42 ± 2.36 (p=0.002), respectively. Our preliminary study has demonstrated the safety and tolerability of HCC infiltrations in patients with VLS, and the effectiveness of HCC in reducing symptoms and, thus, to improve patient Quality of Life.

The SWIFT Model for Lichen Sclerosus Among Premenarchal Girls.

Delay in diagnosis of childhood lichen sclerosus (LS) can be ameliorated with an efficient evaluation tool. We sought to create a useful prognostic tool for rapid and accurate risk stratification for LS in premenarchal girls. We conducted a retrospective chart review at a single institution of premenarchal girls presenting with vulvovaginal complaints at a specialty pediatric and adolescent gynecology clinic at a major academic center. Sixty-nine patients seen between July 2019 and September 2020 were used as a pilot study to create a model for LS based on 18 signs and symptoms. Accuracy of the pilot model was confirmed in a larger data set (additional 105 patients, seen between January 2017 and December 2020), and model parameters were refined through cluster-based analytics. Pilot study yielded 5 predictors for LS: soreness (S), whitening (W), urinary incontinence (I), fissures (F), and thickening of the clitoral hood (T)-SWIFT. The final refined model is given as log odds (LS) = -7 + 3·S + 17·W + 3·I + 3·F + 18·T. This model yielded a >97% accuracy in predicting LS among 174 unique patients (LS prevalence = 18%). The SWIFT model accurately predicts clinical diagnosis of LS in premenarchal girls. Replication in other patient populations is highly encouraged. Awareness of LS is paramount, and an efficient, accurate evaluation tool will prove invaluable in assuring timely diagnosis and treatment for premenarchal patients.

Labial Adhesion Secondary to Lichen Sclerosus Masked by Vulvar Hailey-Hailey Disease.

Labial adhesions in postmenopausal women are caused by various inflammatory processes in the context of estrogen deficiency. Lichen sclerosus (LS) is a chronic, progressive condition characterized by idiopathic epithelial thinning of the anogenital region with symptoms of significant pruritus, discomfort, and dyspareunia. Early diagnosis and treatment of LS can prevent disease progression, leading to labial adhesions and malignancy. We present an 84-year-old woman with long-standing vulvar Hailey-Hailey disease who developed labial adhesions. Clinical examination with vulvar biopsy revealed histopathological findings consistent with LS. Surgical separation of the labia by blunt dissection was then performed, and clobetasol ointment and vaginal dilatators were postoperatively prescribed. This resulted in a significant improvement in her symptoms. This is the first reported case of LS in a patient with Hailey-Hailey disease.

Lymphocyte-Peppered Sclerotic Collagen: An Additional Histological Clue in Lichen Sclerosus, Morphea, and Systemic Sclerosis.

"Line sign," "cookie cutter sign," "square biopsy sign," "high eccrine glands sign" have been previously described in morphoea and lichen sclerosus. We found focal areas of thickened collagen bundles with lymphocytes interspersed between them in several biopsies of these conditions. We reviewed slides of sclerosing disorders obtained from the archives of the pathology department in our hospital for the period 2013-2019. A total of 73 slides including 40 of lichen sclerosus, 24 of morphea, 2 of lichen sclerosus-morphea overlap, and 7 of systemic sclerosis were evaluated. Lymphocytes were noted between sclerotic collagen bundles in 46 (63%) slides, being most common in lichen sclerosus (80%, 32/40) followed by morphea (50%, 12/24), whereas it was seen in one case each of lichen sclerosus with morphea overlap (50%, 1/2) and systemic sclerosis (14.3%, 1/7). The finding was noted in the upper dermis in 20 of 32 (62.5%) slides of lichen sclerosus and in both the superficial and deep dermis in 11 (91.7%) of 12 slides of morphea. Lymphocyte-peppered sclerotic collagen may be a useful histological clue to the diagnosis of lichen sclerosus, morphea, and systemic sclerosis.