Lichen Sclerosus and Keloidal Morphea Overlap: A Case Report of an Unusual Nodular Presentation.
Padol Chamninawakul, Joel Hua Liang Lim
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Case in brief
A 50-year-old woman presented with a solitary, well-circumscribed exophytic nodule on the left posterior thigh, with an ivory-colored peripheral rim and erythematous center. Histopathology showed features of both lichen sclerosus—epidermal atrophy, basal vacuolar alteration, upper dermal collagen homogenization, and a band-like lymphocytic infiltrate—and keloidal morphea, including deep dermal sclerosis with keloidal collagen extending into subcutaneous septa, entrapped adnexal structures, and lymphoplasmacytic inflammation. The findings established an LS–morphea overlap with nodular morphology.
What made this case unusual
The overlap presented as an exophytic nodule with keloidal features, an unusual morphology that broadens the described clinical spectrum of LS–morphea overlap.
Diagnostic / clinical pearl
In a nodular sclerosing lesion, consider LS–morphea overlap when histology combines superficial LS-type changes with deep dermal keloidal sclerosis.
Why it matters
Recognizing this morphology may help avoid diagnostic confusion with other nodular dermal proliferations.