DOI: http://dx.doi.org/10.18203/issn.2455-4529.IntJResDermatol20203747

Diagnostic dermoscopic features and the correlation between dermoscopic and histopathologic features in lichen planus

Sherin Jose, George Kurien

Abstract


Background: Lichen planus (LP) is an autoimmune dermatosis characterized by pruritic violaceous flat-topped polygonal papules predominantly over the extremities but can also affect trunk, mucosa, scalp, palms, soles and nails. Dermoscopy is a novel non-invasive imaging modality and the presence of salient dermoscopic features will help to obviate the need for skin biopsies in many doubtful cases.

Methods: This was a descriptive study of 108 cases of classical lichen planus cases conducted at a tertiary care hospital in South India over a period of one year. Dermoscopic examination of the LP lesions were carried out using DermLite DL3N and histopathological samples were analyzed in 35 cases.

Results: The dermoscopic features were blue globules in 100%, Wickham’s striae in 92.6% and comedo like openings in 49.1%. Vascular patterns were noted only in 13%. On correlating Wickham’s striae in dermoscopy with wedge shaped hyper granulosis on histopathology using the chi-square test we found agreement (kappa value 0.242). We also found that dermoscopy was 93.75% sensitive and 33.33% specific regarding Wickham’s striae in relation to wedge shaped hyper granulosis. In 85% of cases blue globules were present dermoscopically and dermal melanophages were found histopathologically.

Conclusions: Wickham’s striae can be considered as a diagnostic dermoscopic finding in lichen planus whereas findings like bluish pigmentation and vascular structures depended on the skin colour of the patient. We also found agreement between dermoscopic and histopathologic features namely Wickham’s striae with wedge shaped hyper granulosis and blue globules with dermal melanophages.


Keywords


Lichen planus, Dermoscopy, Autoimmune dermatosis

Full Text:

PDF

References


Gorouhi F, Davari P, Fazel N. Cutaneous and Mucosal Lichen Planus: A Comprehensive Review of Clinical Subtypes, Risk Factors, Diagnosis, and Prognosis. Scientific World Journal. 2014;2014:742826.

Gungor S, Topal IO, Goncu EK. Dermoscopic patterns in active and regressive lichen planus and lichen planus variants: A morphological study. Dermatol Pract Concept. 2015;5(2):45-53.

Sonthalia S, Kaliyadan F. Dermoscopy Overview and Extradiagnostic Applications. [Updated 2020 Feb 7]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020. Available from: https://www.ncbi.nlm.nih.gov/books/NBK537131/. Last accessed 4th June 2020.

Garg P, Kaur T, Malhotra S, Singh A. Study of the Dermoscopic Findings and Their Correlation with Histopathological Findings in Various Lichenoid Dermatoses. J Clin Exp Dermatol Res. 2015;6:308.

Lallas A, Kyrgidis A, Tzellos TG, Apalla Z, Karakyriou E, Karatolias A, et al. Accuracy of dermoscopic criteria for the diagnosis of psoriasis, dermatitis, lichen planus and pityriasis rosea. Br J Dermatol. 2012;166(6):1198-205.

Tan C, Min ZS, Xue Y, Zhu WY. Spectrum of dermoscopic patterns in lichen planus: a case series from China. J Cutan Med Surg. 2014;18(1):28-32.

Massi D, Giorgi VD, Soyer HP. Histopathologic correlates of dermoscopic criteria. Dermatol Clin. 2001;19(2):259-68.

Mahajan AS. Demoscopy of Lichen Planus. In: Khopkar U, editor. Dermoscopy and Trichoscopy in diseases of the brown skin. 1st ed. Jaypee Brothers Medical publishers; 2012. p. 114-36.