Clinical, dermoscopic and histopathologic features of genital and extragenital lichen sclerosus

Abstract

Our morphologic study provides novel insights into the morphologic diversity of LS at different body sites and different stages of progression.

Dermoscopic Features of Vulvar Lichen Sclerosus in the Setting of a Prospective Cohort of Patients: New Observations

“…Scales were observed in a higher percentage of cases (14%) compared with a previous dermoscopic analysis of genital LS [15]. In that report, scales were quite common in extragenital forms of LS whereas they were exceptional features in genital LS.…”

“…In contrast, at later stages of progression, dermal fibrosis outweighs vascular changes and could possibly determine the disappearance of dotted vessels at dermoscopy. Linear and dotted vessels were reported in the previous study on VLS dermoscopy as well, even though a correlation between vascular pattern and disease duration was not found [15]. …”

“…These dermoscopic features correspond to sclerosis and hyalinization which are the main pathological changes in LS [15]. White-yellowish patchy structureless areas were described also in a previous analysis on LS dermoscopy, at both genital and extragenital levels [15]. We underline both the presence of a whitish background and some variability in colour of the patchy structureless areas as constant findings of VLS lesions.…”

“…In some cases, white areas were arranged in perfectly round figures, the so-called vulvar white spot disease. These dermoscopic features correspond to sclerosis and hyalinization which are the main pathological changes in LS [15]. White-yellowish patchy structureless areas were described also in a previous analysis on LS dermoscopy, at both genital and extragenital levels [15].…”

“…Selection of the dermoscopic variables included in the evaluation process was based on the literature and personal expertise [15,16,17]. Variables included in the dermoscopic evaluation were the following: (i) vascular morphology (dotted, linear, hairpin, spermatozoa-like); (ii) non-vascular structures: (a) patchy white areas; (b) grey-blue dots (fine or coarse, grey-blue or brown punctate areas); (c) purpuric dots/globules/patches; (d) comedo-like openings (dilated pores with more or less raised borders and filled with yellow, flat horn plugs); (e) corn pearls (rounded, solid, corned structures over the surface of lesions); (f) scales; (g) ‘rusty' spatter-like pattern (diffuse small orange-brownish pinpoint/dotted or squared pigmentation structures variable in size, irregularly distributed), (h) pearly-whitish structures, corresponding to Wickham striae (WS); (iii) background colour (intense red, light red, whitish, white-yellowish).…”