Morphea and Extragenital Lichen Sclerosus Et Atrophicus Overlap

Lichen sclerosus et atrophicus (LSA) is a chronic inflammatory condition that affects mainly the genital regions but can occur extragenitally. Extragenital LSA occurs far less often than the genitally located variety and in most cases has been reported in females. A 36-year-old male engineer presented with chronic itchy lesions on the right forearm for more than a year's duration. On clinical examination, he had hypopigmented atrophic patches with scaling, alopecia, and follicular plugging. Dermoscopy revealed white structureless areas with telangiectasia, comedo-like openings, and peripheral pigment network. Histopathologically, these findings corroborated the presence of hyperkeratosis, epidermal atrophy, thickened collagen, and chronic inflammation. Overlapping LSA with morphea was under consideration since clinical, dermoscopic, and histopathological features were similar between the two conditions. The diagnostic challenge for both disorders resides in their locality in the form of a spectrum of localised sclerosing disorders. This case clearly highlights the importance of combining clinical, dermoscopic, and histopathological assessments for the proper differentiation of LSA from other sclerosing diseases and thus ensuring proper management and care. This is a report on a case that has a unique dermoscopic presentation and may mimic other disorders, necessitating careful diagnostic consideration.