19. Lichen sclerosus et atrophicus vs. morphea

 
Quotation from the 9th edition of Lever's:
 
"Contrasting features of morphea and lichen sclerosus et atrophicus are summarized in Table 10-5 (insert table?). They include relatively little epidermal change in morphea, as compared with thinning of the rete ridges, follicular plugging, and interface alterations of lichen sclerosus. Reticular dermal changes of fibrosis and inflammation of morphea contrast with edema and loss of elastic tissue in lichen sclerosus. Histologic differentiation of the late stage of morphea from lichen sclerosus et atrophicus may cause difficulties, particularly in view of the fact that the two conditions may coexist"
 
"Of interest, lesions of LS may koebnerize (be provoked by trauma) as well as coexist with morphea. In extensive cases of morphea, lichen sclerosus et atrophicus may become superimposed on some of the lesions."
 
"Cases of overlap of morphea and LS may be seen and demonstrate the histologic changes of both disorders in their respective locations of the dermais."
 
Reference in the 9th edition to concepts contrary by A. Bernard Ackerman et al. (ABA): None.
 
Statements contrary by ABA:
 
"Error: Lichen sclerosus et atrophicus is a disease of the papillary dermis. Reason: Although "lichen sclerosus et atrophicus" involves principally the papillary dermis, which is thickened by sclerosis of it, associated with it always are changes typical of conventional morphea in at least the uppermost part of the reticular dermis (crowded, thickened bundles of collagen aligned parallel to the skin surface), as well as alterations of the dermo-epidermal junction and of the epidermis; the "changes typical of conventional morphea" are not surprising because, in reality, lichen sclerosus et atrophicus simply is a superficial expression of morphea, in contrast to fasciitis with eosinophilia which is a deep manifestation of it."
 
Ackerman AB, Böer A, Bennin B, Gottlieb GJ. Histologic Diagnosis of Inflammatory Skin Diseases, 3rd Edition. New York: Ardor Scribendi, 2005. (www.derm101.com)
 
Other works of ABA in which the ideas contrary are expressed:
 
1. Ackerman AB, Mones J. Resolving Quandaries in Dermatology, Pathology and Dermatopathology. pp 316. New York: Ardor Scribendi, 2001.
 
2. Ackerman AB. Chongchitnant N, Sanchez J, Guo Y. Histologic Diagnosis of Inflammatory Skin Diseases. 2nd edition. Baltimore: Lippincott Williams & Wilkins, 1997.