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 Table of Contents  
Year : 2021  |  Volume : 5  |  Issue : 2  |  Page : 251-252

Diagnostic perplexity in hypertrophic lichen planus: Dermoscopy saves the day!

1 Department of Pediatric Dermatology, Cloudnine Hospital, Bengaluru, India
2 Department of Dermatology, S N Medical College, Bagalkot, Karnataka, India
3 Department of Dermatology, Krishna Institute of Medical Sciences (Deemed to be University), Karad, Maharashtra, India

Date of Submission06-Mar-2020
Date of Decision18-Jul-2020
Date of Acceptance22-Sep-2020
Date of Web Publication26-Aug-2021

Correspondence Address:
Balachandra S Ankad
Department of Dermatology, S. Nijalingappa Medical College, Navanagar, Bagalkot - 587 102, Karnataka
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/CDR.CDR_59_20

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How to cite this article:
Mukherjee SS, Ankad BS, Smitha S V, Nikam BP. Diagnostic perplexity in hypertrophic lichen planus: Dermoscopy saves the day!. Clin Dermatol Rev 2021;5:251-2

How to cite this URL:
Mukherjee SS, Ankad BS, Smitha S V, Nikam BP. Diagnostic perplexity in hypertrophic lichen planus: Dermoscopy saves the day!. Clin Dermatol Rev [serial online] 2021 [cited 2021 Dec 1];5:251-2. Available from: https://www.cdriadvlkn.org/text.asp?2021/5/2/251/324568

  Clinical Scenario Top

A 37-year-old male, corporate professional by occupation, presented to the dermatology clinic with complaints of asymptomatic thickened lesions over the right ankle of about 3 years' duration, progressively increasing in size. History revealed that he would sit with the right leg folded on the floor most often. He used to apply 6% salicylic acid ointment on and off, which was associated with only partial resolution and recurrence on discontinuation. Clinical examination revealed a thick keratotic plaque with verrucous surface on the right ankle with two other discrete, satellite plaques in proximity to the primary plaque [Figure 1]a. A differential diagnosis of callosity, tuberculosis verrucosa cutis (TBVC), and wart was considered.
Figure 1: (a) Clinical image showing hypertrophic and hyperkeratotic plaques on the leg. Site of dermoscopic examination is shown (white and yellow arrows). (b) Hyperkeratosis (yellow star), follicular plugging (red star), acanthosis (black star), and elongation of rete ridges (red arrow) along with band-like inflammatory infiltrate (white stars) on histopathology (H and E, 10x)

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  Diagnostic Pearl Top

Dermoscopic examination of the lesion done with DermLite DL3N (3Gen, San Juan Capistrano, California, USA) in the polarized mode revealed pale white, structureless area at the center and multiple follicular plugs suggestive of “corn pearls,” white scales, thick keratotic crust, red dots and globules, and brown areas. The bluish background was conspicuous [Figure 2]a, [Figure 2]b and [Figure 3]a, [Figure 3]b. The dermoscopic diagnosis was consistent with hypertrophic lichen planus, which was further confirmed on histopathology [Figure 1]b.
Figure 2: Dermoscopy from the site marked as yellow arrows in Figure 1a shows pale white, structureless areas (yellow stars), comedo-like openings (yellow arrows), and white superficial scales (a and b). Note the bluish background (green stars) (a) and brown areas (red stars) (b). (polarized, contact, ×10)

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Figure 3: Dermoscopy from the site marked as white arrows in Figure 1a shows white scales (red stars), comedo-like openings (red arrows), and red dots and globules (yellow circles). Note the bluish background (yellow stars) and brown areas (yellow arrows) (a and b) (nonpolarized, contact, ×10)

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  Significance of the Pearl Top

Dermoscopy is a rapid, noninvasive, bedside, office-based tool that is now being increasingly used not only in screening but also for diagnostic purposes. It is not uncommon to have diagnostic dermoscopic surprises in routine clinical practice. As in our patient also when the differential diagnosis of hypertrophic lichen planus was not suspected clinically, dermoscopy nearly clinched the diagnosis of the same. Comedo-like openings or follicular plugs were described as openings filled with yellow keratinous plugs by Vázquez-López et al.[1] They correspond to dilatation, plugging, and hypergranulosis of the infundibula and are suggestive of transepithelial elimination.[2],[3] Bluish background, white scales and crusts, pale white areas, brown areas, and red globules represent dermal melanin, hyperkeratosis and parakeratosis, acanthosis, epidermal melanin, and dilated capillaries, respectively. Dermoscopy in callosity reveals hyperkeratotic surface and homogenous opaque yellowish area with preservation of dermatoglyphics. Wart shows characteristic red dots or globules with whitish halo.[4] TBVC is typified by yellow areas with well-focused linear and branching vessels. Thus, dermoscopy is a reliable, simple, and easy-to-use diagnostic technique that serves as a link between macroscopic skin lesions and microscopic histopathological features.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient (s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initial s will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

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Conflicts of interest

There are no conflicts of interest.

  References Top

Vázquez-López F, Manjón-Haces JA, Maldonado-Seral C, Raya-Aguado C, Pérez-Oliva N, Marghoob AA. Dermoscopic features of plaque psoriasis and lichen planus: New observations. Dermatology 2003;207:151-6.  Back to cited text no. 1
Ankad BS, Beergouder SL. Hypertrophic lichen planus versus prurigo nodularis: A dermoscopic perspective. Dermatol Pract Concept 2016;6:9-15.  Back to cited text no. 2
Jha AK, Raihan M. Dermoscopy of lichen planus hypertrophicus: A retrospective analysis. J Pak Assoc Dermatol 2017;27:64-6.  Back to cited text no. 3
Bae JM, Kang H, Kim HO, Park YM. Differential diagnosis of plantar wart from corn, callus and healed wart with the aid of dermoscopy. Br J Dermatol 2009;160:220-2.  Back to cited text no. 4


  [Figure 1], [Figure 2], [Figure 3]


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