History:

This asymptomatic white plaque was present on one breast for 5 years, during which time it had slowly increased in size. Recently some hemorrhage had occurred into the area. A new area had recently arisen without any apparent preceding inflammation.

This is lichen sclerosus. The redness is due to telangiectasia in the skin. Most cases occur in the genital skin and around the anus but this lady's lesions were all extragenital.This is late stage disease when no treatment works. In early stage disease high potency topical steroids can help stop the process and relieve the very troublesome itch. Tacrolimus 0.1% ointment is also useful.