One Year Hospital Based Observational Study Of Clinical And Dermatoscopic Correlation In Lichen Planus

Abstract

Lichen planus (LP) is an inflammatory mucocutaneous condition that exhibits a distinct morphological and histopathological features. Classically presents as itchy lesions described as “pruritic, purple, polygonal, planar, papules, and plaques” affecting the flexors of extremities. Dermoscopy is a method of visualizing subsurface skin patterns. It is used to study infective as well as inflammatory disorders of skin, hair disorders and diseases of the nails. The patterns of dermoscopic examination of lichen planus helps in clinching the diagnosis and noting the improvement during follow up of patients. Dermoscopy findings in lichen planus consists of variable forms of whitish structures that correlates to Wickham’s Striae (WS) with borders showing vascular structures. We undertook this study to look for the skin structure changes in various morphologic cutaneous LP cases and to correlate them with their dermoscopic features so as to expand our knowledge about lichen planus and avoid the invasive skin biopsy for confirmation of diagnosis. Methodology The one year hospital based observational study was done on a total of 70 lichen planus patients who attended KLES Dr. Prabhakar Kore Hospital and Medical Research Centre, Belagavi from January 2018 to December 2018. A written consent form was obtained. A detailed history regarding the age, sex, duration of the disease and history of other disease associated was taken. Clinical photographs of the lesions were taken. Dermatological and systemic examination was carried out. Diagnosis of lichen planus was made on clinical examination. Dermoscopic examination of the lesions was performed using a videodermatoscope ( Dinolite 2.0 ) providing 50X and 200X magnification and photographs were recorded in nonpolarized as well as polarized mode. The data and photographic record was noted in a pre-designed proforma after taking informed and written consent. An ethical committee clearance was obtained prior to the start of the study. The results were analysed by SPSS software, correlation method, fisher exact test and chi-square test Results In our study, 56% patients (39/70) had classical LP, 14% patients (10/70) had hypertrophic LP which were the most common clinical variants of LP. Reticulate pattern of WS was the most common pattern observed in our study 40% (28/70) and a new pattern of WS a rosette/ pettaloid pattern 13% (9/70) was observed in our patients. The occurrence of WS was significantly associated with clinical variants of LP. The nonvascular findings observed on dermoscopy were comedone like openings and grey blue dots which were statistically significant with clinical variants of LP. Among the pigmentary findings, pepper like pigmentation was mostly seen in the CLP 64% (25/39) and reticulate pattern was statistically significant in LPp 85% (6/7). Perifolliclar pigmentation was statistically significant in LPP 100% (2/2) Conclusion This study demonstrates the variability of dermoscopy patterns in different clinical variants of LP. The use of dermoscopy helps in best visualization of the characteristic WS, blood vessels and pigmentary changes in cases of LP and aids in reducing unnecessary biopsies required for diagnosing lichen planus. The strength of associations of some dermoscopic features such as red dots, WS, perifollicular pigmentation and reticulate pigmentation in our study have been repeatedly confirmed by several other observational studies. The limitations of our study includes a smaller sample size, hence to conclude the significance of findings on dermoscopy of lichen planus a study with larger sample size is needed.