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clinical:
| • | slightly raised or level with the surface of the skin (later depressed) |
| • | typically the surface shows prominent dilated pilosebaceous or sweat duct orifices which often contain yellow or brown, horny plugs |
| • | petechiae = clue to diagnosis |
| • | ddx: morphea, atrophic LP |
| • | ¾ of female patients have one or more organ specific auto-antibody (e.g. thyroid or gastric parietal cells) |
| • | LS&A of the penis (aka balanitis xerotica obliterans) - occurs on the glans penis (follicular plugging absent because there are no follicles on the glans) |
| • | may degenerate into SCC (especially in the vulva) |
LS and A of the vulva:
| • | spares the vagina (vulva only) |
| • | telangiectasia makes the diagnosis |
| • | ddx: intertrigo with atrophy secondary to strong topical glucocorticoids |
mnemonic (to remember affect age group for these diseases):
| • | vulva LS et A in women: most common before puberty often will spontaneously improve upon puberty and after menopause |
| • | an exact opposite to Fox-Fordyce disease: which begins after puberty and may remain until menopause |
histology:
| • | thinning of the epidermis but hyperkeratosis |
| • | vacuolar alteration of the basal layer |
| • | lymphedema of the papillary dermis; bleeding into skin due to capillary fragility (like the pinch purpura of amyloid) |
| • | beneath the edema there is a diffuse, perivascular infiltrate of lymphocytes in the mid dermis |
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