Hypopigmented plaque with cut dragon fruit appearance

A 32-year-old male presented with a whitish, hypopigmented asymptomatic skin lesion over his upper back for six months, with no similar lesions reported elsewhere. On examination, a 5 × 5 cm hypopigmented atrophic plaque, with follicular plugging and peripheral hyperpigmentation was observed on the right upper back, resembling the appearance of a cut dragon fruit [Figure 1]. Dermoscopy revealed structureless areas, comedo-like openings, white chrysalis-like structures, and telangiectasia. Histopathology showed follicular plugging, epidermal thinning, loss of rete ridges, focal basal cell vacuolization, and edema and hyalinization of the papillary dermis [Figure 2]. After correlating clinical findings, dermoscopic results, and histopathological features, the diagnosis of extragenital lichen sclerosus et atrophicus (LSA) was made.

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Figure 1:

Peripheral hyperpigmentation corresponds to the fruit’s surface (black arrow), sclerosis corresponds to the fruit’s pulp (orange arrow), and dots indicate follicular plugging, which corresponds to the fruit’s seed (blue arrow).

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Figure 2:

Histopathology showing epidermal thinning, loss of rete ridges, focal basal cell vacuolization, and edema and hyalinization of the papillary dermis (H&E ×40). H&E: Hematoxylin and eosin.

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LSA is a chronic inflammatory skin condition affecting both anogenital and extragenital areas. Extragenital LSA lesions typically begin as polygonal, bluish-white papules that merge into atrophic plaques.^[1] In the early stages, these plaques often exhibit prominent follicular plugs, which gradually disappear, leaving smooth, porcelain-like plaques behind. The similarity between these follicular plugs and the seeds within the pulp of a cut dragon fruit underscores the natural world’s influence on dermatological terminology.^[2]