Dermoscopy

Dermoscopic features of Lichen planus

Dermoscopic features in Lichen planus:

  • The most characteristic feature of lichen planus seen in dermoscopy is Wickham striae which histopathologically corresponds to hypergranulosis. 
  • They appear typically white in colour but may also appear blue in dark skinned people.
  • Various morphologies of wickham striae are seen – like leaf venation, radial, linear, globular etc.,

But white structures in a net like pattern can also be seen in scarring or resolving lesions of other skin conditions like DLE, prurigo nodularis – called as Pseudo Wickham striae. It is due to dermal fibrosis.

  • This pseudo wickham striae can be differentiated from the wickham striae seen in Lichen planus by the vascular morphology – the vessels appear more dilated in pseudo WS than those seen in WS

Other findings in active lesions:

  • Dotted or globular or linear vessels mainly detected on the periphery of the lesions
  • White/yellow dots
  • pigmentary structures

 

The dermoscopic patterns in lichen planus differs according to the stage of the condition – 

  •      The early popular lesions show only faintly visible WS over a red background.
  •      In later stages of the disease, the mature lesions show well formed WS and peripherally distributed vessels.
  •      In the more chronic lesions – often only pigmentary structures are seen.

 

Hypertrophic Lichen planus:

  • Shows follicular keratotic plugging
  • WS are not seen often
  • Comedo like openings
About Author

Balavignesh

M.D DVL Post Graduate, Madras Medical College and RGGGH Chennai

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