Role of dermoscopy in the diagnosis of hypertrophic lichen planus and prurigo nodularis

Abstract

Background:A dermoscope is an office tool used in the diagnosis of various disorders. At present, studies on hypertrophic lichen planus (HLP) and prurigo nodularis (PN) are limited.Aims and Objectives:The aim of this study was to compare the dermoscopic features of HLP and PN and to determine the role of dermoscopy in the differential diagnosis of both the conditions.Materials and Methods:A cross-sectional study was undertaken. After clinical assessment and relevant investigations, dermoscopy was performed using DermLite DL3 dermoscope (×10) followed by histopathology. Dermoscopic findings in cases of HLP and PN were evaluated.Results:Thirty patients each with HLP and PN were included in the study. On dermoscopy, peripheral striations were the most common findings in both the conditions. Statistically significant features on intergroup comparison included blue–gray globules (P<0.001), comedo-like openings (P<0.001), and follicular plugging (P<0.001) in HLP and pearly white areas with white starburst pattern (P=0.028), red dots and globules (P<0.001), glomerular vessels (P=0.003), crusting (P=0.002), and erosions (P<0.001) in PN.Conclusion:Dermoscopy is useful in differentiating HLP and PN. Blue-gray globules, comedo-like openings, and follicular plugging were specific for HLP. Pearly white areas with white starburst pattern and red dots and globules were the specific findings in PN.

Evaluation of Dermoscopic Patterns of Vesiculobullous Disorders

“…[ 22 ] Blue-gray globules (pigment-laden melanophages in the dermis) are also specific for LP diagnosis. [ 23 ] EB lesions are characterized by shiny white rosettes (resembling a four-leaf clover, 0.2–0.5 mm in size). [ 24 25 ] They are postulated to result from the optical effect of polarized light, narrowing of infundibula, blockage by keratin, or alternating areas of focal hyperkeratosis, normal corneal layer, and keratin-filled acrosyringeal openings.…”

Dermoscopy of inflammatory skin diseases

“…Beim hypertrophen Lichen planus treten follikuläre Hornpfropfen, komedoartige Follikelöffnungen und gelbliche Areale auf. In diesem Fall sind die Wickham-Streifen nicht sichtbar, da sie unter der hyperkeratotischen Masse verborgen sind [ 15 ]. Beim porokeratotischen Lichen planus sind in dem Bereich, der von einem weißen hyperkeratotischen Rand umgeben ist, gepunktete Gefäße zu sehen, und in der Mitte sind bräunliche Pigmentflecken zu erkennen [ 16 ].…”

Hypertrophic lichen planus of the soles: A rare variant in a rare location

“…Dermoscopic features of classic LP have been widely described. Recently, more reports of LP variants have found some dermoscopic structures to be more specific of hypertrophic LP than others, such as comedo-like openings, also known as corn pearls, peripheral striations, bluish-gray/brown globules, and a globular pattern of Wickham striae [4,5]. On dermoscopy, corn pearls may increase in number and size and conglomerate forming a "bouquet of white roses," which reflects the degree of hyperkeratosis [6].…”