Lichen Sclerosus et Atrophicus of the Eyelid
2009, Volume 2, Number 1 33 Competency Corner Case Report Lichen sclerosus et atrophicus is a disease primarily found in the genital area of women. Up to 20% of patients with genital disease have extragenital mani-festations; it is rarely a sole extragenital finding and often occurs in the submammary region, shoulder, or neck. This disease is similar in presentation to discoid lupus and morphea, a localized form of scleroderma; however, the pathophysiology is clinically distinct due to elastic tissue involvement [1]. Although rare, lichen sclerosus et atrophicus should be considered in the differential of destructive eyelid lesions. Report of a Case A 22-year-old Hispanic American male complained of approximately two months of right upper eyelid swelling, itchiness, and tearing. No relief was achieved with fexofenadine, hydroxyzine, hydrocorti-sone 1% cream, or a methylprednisolone dosepack. On initial examination, his uncorrected visual acuity was 20/20, and intraocular pressure was 15 mm Hg in the affected eye. No corneal defects and no lesions of the lower lid conjunctiva were evident. The anterior chamber was deep and quiet. Examination of the right upper lid and brow revealed a white, geographic plaque with a violaceous border and madarosis of the eyelashes and eyebrow hairs (Figure 1). The upper eyelid skin was thickened with multiple comedone-like keratin plugs. With upper lid eversion, the palpe-bral conjunctiva appeared thickened and glossy-white. Working collaboratively with dermatology staff, we found the lesion to be clinically consistent with mor-phea, discoid lupus, or lichen sclerosus et atrophicus. No additional lesions were identified. Evaluation of a biopsy revealed hyperkeratosis, epidermal atrophy, and follicular plugging. Basal layer hydropic degen-eration and a superficial dermal edema were evident. There were inflammatory infiltrates around periadnexal structures and collagen deposition ar-ranged parallel to the skin surface (Figure 2). These microscopic findings were most consistent with lichen Lichen Sclerosus et Atrophicus of the Eyelid John B. Cason, MD 1* , Avery A. Bevin, MD 2 , and Elizabeth M. Hofmeister, MD 1 1 Department of Ophthalmology, Naval Medical Center San Diego, San Diego, CA 2 Department of Dermatology, Naval Medical Center San Diego, San Diego, CA * Corresponding Author & e-mail: John.Cason@med.navy.mil Accepted for publication March 25, 2009 Revision received May 5, 2009 2009; 2: 33-35. Available via open-access on the web at http://www.academic-ophthalmology.com The author(s) have no personal financial interest in any of the products or technologies cited herein. The views expressed in this paper are those of the authors and do not necessarily reflect the official policy of the Department of the Navy, Department of Defense, or the United States Gov-ernment. Â 2009 Right upper eyelid shown with waxy thickening of superficial skin layers and follicle destruction. Basal layer hydropic changes, dermal fibrosis and periadnexal chronic inflammatory changes.