Lichen Scierosus et Atrophicus in N igerians W.K. Jacyk, MD, and F. Isaac, MD Zaria, Nigeria

Lichen sclerosus et atrophicus has been considered very rare in the native African population. Only seven cases, all among the Bantu, have been described to date. Five cases are now reported and these cases are believed to be the first from West Africa. Lichen sclerosus et atrophicus (LSA) is a rare condition in Africans. The seven cases described in Africa all have been observed in the Bantu of South Africa, two cases of Scott and Lups' and five cases of Dogliotti et al.2 No single case of LSA was found in large series of dermatologic patients seen by Shrank and Harman,3 in Western Nigeria; Verhagen,4 in Kenya; Vollum,5 in Uganda; and Rampen,6 in Malawi. The purpose of this communication is to describe five cases of LSA seen in Nigerians. These are believed to be the first documented cases of the condition in Africans outside South Africa.

mis and homogenization of collagen in the upper dermis (Figure 2).

Case 1 A 39-year-old Zuru woman had first noticed skin lesions on the flexor surfaces of her forearms eight years ago. She had innumerable, itchy, small, shiny, ivory, round macules on her trunk and arms (Figure 1). The macules were atrophic and showed cigarettepaper wrinkling on the surface. There were also several elevated plaque-like lesions on the dorsal aspect of the tongue. Biopsy of a skin lesion showed hyperkeratosis, thinning of the rete Malpighi, hydropic degeneration of the basal cells, a mild chronic inflammatory infiltrate in the mid and upper der-

Requests for reprints should be addressed to Dr. W.K. Jacyk, Skin Unit, Department of Medicine, Ahmadu Bello University Hospital, Zaria, Nigeria.

A 19-year-old Hausa woman had widespread LSA skin lesions affecting the lower and upper extremities, and back and front of the chest. There was also histologically confirmed anogenital involvement with plaque-like lesions on the vulva and around the anus.


Case 2 A 25-year-old Tiv woman had developed several pruritic plaques and papules, consistent clinically with LSA, on the upper trunk, both arms, and the left thigh. Parchment-like atrophy was evident in the central part of the plaques and shiny, yellowish, indurated papules were clearly visible on the periphery of the plaques (Figure 3). The histological features were typical for LSA.

Case 3 Case Reports

Case 5

A 20-year-old Hausa woman had a single large atrophic plaque surrounded by shiny white papules on the neck. The clinical suggestion of LSA was histologically proved.

Case 4 A 35-year-old Tiv woman presented widespread skin lesions affecting extensive areas on the trunk, buttocks, lower and upper limbs, and the nape of the neck. She gave a four-year history of the disease which spread rapidly. The first lesion was on the neck. Lesions consisted of large, shiny, darker patches with an atrophice surface (Figure 4). Sharp delineation was additionally accentuated by lighter, angular and flat papules distributed on the margin of the plaques. All lesions were moderately pruritic. On histologic examination features of LSA were found.


All five cases were clinically and histologically consistent with the diagnosis of LSA. The term "white spot disease" fits well with the clinical presentation of case 1. In this case, lesions were also found in the oral cavity. Similar tongue lesions were observed also in one Bantu case of Dogliotti et al. Only one of our patients had anogenital lesions. In case 4, lesions were very extensive, involving more than half of the body surface. A striking feature in this case was hyperpigmentation in otherwise typical LSA lesions. This feature, unusual in Caucasians, seems not to be so uncommon in African patients. Similar deepening of pigmentation was also found in two cases of Dogliotti et al. There is little information on the frequency of LSA in individuals of different races and living in different climatic conditions. Although a number of cases have recently been described in Afro-Americans, the general opinion is that the condition is much more common among Caucasians. The frequency of LSA in Britain, according to Wallace,7 varies between one and three percent of dermatologic patients. The five cases of LSA presented here constitute .03 percent of all patients seen in dermatologic practice in a busy West African clinic during a period of over four years. As the etiology of LSA remains unknown, it is difficult to explain the evident variation in environmental incidence. There is evidence that most of the diseases in which autoimmune processes are thought to be involved are 387

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Figure 4. Case 4. Extensive lichen sclerosus et atrophicus lesions with hyperpigmentation.

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uncommon in Nigeria and in some other parts of tropical Africa (Greenwood8).> ,,m*;vs If autoimmune mechanisms are operative in LSA (Goolamali et a19) the lower incidence of this condition in the tropical environment could reflect this phenomenon.

Literature Cited 1. Scott FP, Lups JG: Lichen sclerosis et atrophicans by die Bantoe. Geneeskunde 13:76, 1971 2. Dogliotti M, Bentley-Philips CB, Schmaman A: Lichen sclerosus et atrophicus in the Bantu. Br J Dermatol 91:81-85, 1974 3. Shrank AB, Harman RR: The incidence of skin disease in a Nigerian teaching hospital dermatological clinic. Br J Dermatol 78:235241, 1966 4. Verhagen AR: Skin diseases in Kenya. Arch Dermatol 98:577-586, 1968 5. Vollum Dl: An impression of dermatology in Uganda. Trans St John's Hosp Dermatol Soc 59:120-128, 1973 6. Rampen F: The spectrum of dermatology in Malawi. East Afr Med J 53:398-406, 1976 7. Wallace HJ: Lichen sclerosus et atrophicus. Trans St John's Hosp Dermatol Soc 57:9-12, 1971 8. Greenwood BM: Autoimmune disease and parasitic infections in Nigerians. Lancet 2 :380-382, 1968 9. Goolamali SK, et al: Organ-specific antibodies in patients with lichen sclerosus. Br Med J 4:78-79, 1974


Lichen sclerosus et atrophicus in Nigerians.

Lichen Scierosus et Atrophicus in N igerians W.K. Jacyk, MD, and F. Isaac, MD Zaria, Nigeria Lichen sclerosus et atrophicus has been considered very...
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