Description: Comedolike plugs

History: This 58-year-old woman developed progressive atrophic papules and plaques on her back. Skin biopsies showed changes consistent with Lichen sclerosis et atrophicus. No lesions were found on the mucosal areas. Dermoscopic description: comedolike plugs correspond to obliterated appendiceal ostia. Lichen sclerosus (LS) is a chronic inflammatory dermatosis that results in white plaques with epidermal atrophy. LS has both genital and extragenital presentations. It is reported under a variety of other appellations such as lichen sclerosus et atrophicus (dermatological literature), balanitis xerotica obliterans (glans penis presentation), and kraurosis vulvae (older description of vulvar presentation). An increased risk of squamous cell carcinoma may exist in vulvar disease, but the precise increase in risk and what cofactors (human papilloma virus infection or prior radiotherapy) may be involved are not yet completely defined. In large series, genital presentations, both vulvar and penile, outnumber extragenital reports by more than 5:1.