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  - Disclaimer- 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.

1. Dr.Joana Thimjo
Department of Dermatology & Venerology
University Hospital Center “Mother Teresa”, Tirana, Albania

2. 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.
SCLERO.ORG
by the nonprofit
International Scleroderma Network

3. CASE PRESENTATION
A seven years old girl (M.S) admitted to our
clinic on 25/10/2011, reporting a four year history with these
complaints :
 Appearing of white lesions in perivulvar and peri-anal region.
 Severe burning and itching in the vaginal area.
 Malodorous secretions.

4. CLINICAL PRESENTATION
The 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. 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. 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. FAMILIAR HISTORY
The girl’s mother didn’t report any family history for:
 Vitiligo
 Lichen Sclerosus et Atrophicus
 Endocrinological diseases
 Autoimmune diseases

8. DIFFERENTIAL DIAGNOSIS
 PIEBALDISM
 LICHEN SCLEROSUS et ATROPHICUS
 NEVUS DEPIGMENTOSUM
 POST INFECTIOUS AND POST TRAUMATIC
DEPIGMENTATION
 PSORIASIS INVERSA
 MORFEA
 INTERTRIGO CANDIDIASIS
 SEXUAL ABUSE

9. LAB BLOOD EXAMINATIONS
 T4, TSH
 Glucose, HbA1c
 CBC
All the examinations resulted within normal range

10. OTHER EXAMINATIONS
 Thyroid ECHO
 Examination with KOH preparations to rule out fungal
infection
There were no evident problems

11. CONSULTATIONS
 Pediatric geneticist
 Pediatric endocrinologist
And to rule out sexual abuse we also performed
consultations with:
 Gynecologist
 Infantile psychiatrist
All the consultations resulted normal

12. HISTOLOGICAL FINDINGS
In 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. MICRO IMAGES

14. HISTOPATHOLOGICAL DIAGNOSIS
The Histopathological Diagnosis was:
LICHEN SCLEROSUS ET ATROPHICUS

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. 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. 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. THANK YOU
Dr. Joana Thimjo
Department of Dermatology & Venerology
University Hospital Center “Mother Teresa”, Tirana, Albania