Vitiligo or lichen sclerosus - a case report - Dr. Joana Thimjo

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I went to several doctors. I was told it was a fungus and, further, that it was clearly all in my head. I went to a dermatologist who told me it was Vitiligo.
Another said it was Lichen sclerosus.
1- A case of simultaneously occurring Lichen Sclerosus
and segmental Vitiligo : connecting the underlying
autoimmune pathogenesis
Authors WEISBERG ERIC L;LE LU Q;COHEN JACK B , International Journal of Dermatology ISSN 011-
9059 ,2008,VOL 47,pp.1053-1055

2- Vitiligoid lichen sclerosus : A reappraisal
Attili VR, Attilli SK. Indian J Dermatol Venereol Leprol 2008 ; 74 : 118-21

3- Report of a new case with four skin diseases ( Lichen
planus, vitiligo, lichen sclerosis, and disseminated
actinic porokeratosis)
Javad Golchai and Afshar Ramezanpour , Dermatology Online Journal 9 (1): 15

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This PPT is loaded as student material "as is", from the VRF Vitiligo Master Class Barcelona November 2011; VRF does not endorse or otherwise approve it.

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Vitiligo or lichen sclerosus - a case report - Dr. Joana Thimjo

  1. 1. Dr.Joana Thimjo Department of Dermatology & VenerologyUniversity Hospital Center “Mother Teresa”, Tirana, Albania
  2. 2. I went to several doctors. I was told it was a fungusand, further, that it was clearly all in my head. I went to adermatologist who told me it was Vitiligo.Another said it was Lichen sclerosus.SCLERO.ORGby the nonprofitInternational Scleroderma Network
  3. 3. CASE PRESENTATIONA seven years old girl (M.S) admitted to ourclinic on 25/10/2011, reporting a four year history with thesecomplaints : Appearing of white lesions in perivulvar and peri-anal region. Severe burning and itching in the vaginal area. Malodorous secretions.
  4. 4. CLINICAL PRESENTATIONThe lesion is: Localized in the perivulvar&peri-anal region White demarcated macules Symmetrically spread Irregular, indistinct border from the normal tissue Vascularization grouped in asymmetrical way In the vulvar area are present ivory white semitransparent plaques Tender No desquamation, excoriation,crusts and secretions
  5. 5. ANAMNESIS MORBI The disease begun 4 years ago, during a bath wash the mother noticed white macules in the genital area of the child, which were followed by subjective complaints such as pruritis,itching and malodorous secretions. She had made consultations with different dermatologist during this period, and lately was treated for a two week period with antimycotic and topical emollients, but didn’t have any improvement.
  6. 6. ANAMNESIS VITAE She denied other previous or concomitant diseases Didn’t have any contacts with industrial chemicals Didn’t have any Contact Allergic History Didn’t have a history of Genital Herpes Didn’t have a history of Psoriasis Inversa
  7. 7. FAMILIAR HISTORY The girl’s mother didn’t report any family history for: Vitiligo Lichen Sclerosus et Atrophicus Endocrinological diseases Autoimmune diseases
  8. 8. DIFFERENTIAL DIAGNOSIS PIEBALDISM LICHEN SCLEROSUS et ATROPHICUS NEVUS DEPIGMENTOSUM POST INFECTIOUS AND POST TRAUMATIC DEPIGMENTATION PSORIASIS INVERSA MORFEA INTERTRIGO CANDIDIASIS SEXUAL ABUSE
  9. 9. LAB BLOOD EXAMINATIONS T4, TSH Glucose, HbA1c CBCAll the examinations resulted within normal range
  10. 10. OTHER EXAMINATIONS Thyroid ECHO Examination with KOH preparations to rule out fungal infection There were no evident problems
  11. 11. CONSULTATIONS Pediatric geneticist Pediatric endocrinologistAnd to rule out sexual abuse we also performed consultations with: Gynecologist Infantile psychiatristAll the consultations resulted normal
  12. 12. HISTOLOGICAL FINDINGSIn the microscopic examinaton was seen : Hyperkeratosis within stratum corneum of epidermis. Slight areas of vacuolization along dermal-epidermal junction. Sclerosis of a markedly thickened papillary dermis
  13. 13. MICRO IMAGES
  14. 14. HISTOPATHOLOGICAL DIAGNOSIS The Histopathological Diagnosis was: LICHEN SCLEROSUS ET ATROPHICUS
  15. 15. CASES DESCRIBED IN LITERATURE 1- A case of simultaneously occurring Lichen Sclerosus and segmental Vitiligo : connecting the underlying autoimmune pathogenesis Authors WEISBERG ERIC L;LE LU Q;COHEN JACK B , International Journal of Dermatology ISSN 011- 9059 ,2008,VOL 47,pp.1053-1055 2- Vitiligoid lichen sclerosus : A reappraisal Attili VR, Attilli SK. Indian J Dermatol Venereol Leprol 2008 ; 74 : 118-21 3- Report of a new case with four skin diseases ( Lichen planus, vitiligo, lichen sclerosis, and disseminated actinic porokeratosis) Javad Golchai and Afshar Ramezanpour , Dermatology Online Journal 9 (1): 15
  16. 16. DISCUSSION Although the histopathological diagnoses resulted ”Lichen Sclerosus et Atrophicus”, we still consider the “Vitiligo and Lichen Sclerosus et Atrophicus” Diagnose . At this point the best choice could be taking a second biopsy, but… due to the inappropriate localization and the age of the patient it was difficult.
  17. 17. TREATMENT According to the same way of treatment of Vitiligo & Lichen Sclerosus et Atrophicus, we decided to give her mid-potency corticosteroids. Considering the magliancy risk of LS the patient was asked to be kept in observation.
  18. 18. THANK YOUDr. Joana ThimjoDepartment of Dermatology & VenerologyUniversity Hospital Center “Mother Teresa”, Tirana, Albania

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