Atypical presentation of lichen sclerosus et atrophicus: depigmented confetti-like papules in the supraclavicular region

Lichen sclerosus et atrophicus (LSA) is a chronic inflammatory dermatosis, typically characterized by ivory-white, atrophic plaques, affecting the anogenital region most commonly. This case report describes an atypical presentation of LSA in a 30-year-old male who presented with a two-year history of multiple depigmented papules in a confetti-like, bilaterally symmetrical pattern over the supraclavicular areas. A dermoscopic examination revealed follicular plugging and telangiectasia. A punch biopsy of a lesion showed homogenization of collagen in the upper dermis and a lymphocytic infiltrate below, as well as in a perifollicular distribution, thereby confirming the diagnosis of LSA. This report highlights the importance of the use of dermoscopy while examining these atypical cases and to consider LSA in the differential diagnosis of depigmented lesions in extragenital locations and underscores the diverse clinical presentations of this disease.