Clinico-Dermatoscopic Study of Lichen Planus With Histopathological Correlation

Objectives: Lichen planus (LP) is a chronic papulosquamous disease that presents as shiny, violaceous, flat-topped, polygonal papules. Diagnosis is usually clinical, although dermatoscopy and biopsy may be needed in cases of diagnostic dilemma. As recent trends favour non-invasive modalities, the role of dermatoscopy has significantly increased. It appears to be a more convenient, safer, and quicker diagnostic modality compared to conventional histopathological examination. We aimed to study the clinical and dermatoscopic features of different variants of lichen planus and to correlate clinical and dermatoscopic features with histopathological findings. Material and Methods: The prospective observational study was conducted on patients with cutaneous LP. A total of 102 patients were included in the study after applying the inclusion and exclusion criteria. Patient particulars, clinical examination, dermatoscopic examination, and histopathological examination (HPE) were performed, and the findings were noted. Results: Female preponderance was observed (56.9% of cases) in our study, with a female-to-male ratio of 1.31:1. Classic lichen planus [59 (57.8%)] constituted most patients in our study, followed by hypertrophic lichen planus [18 (17.7%)]. On dermatoscopy of classic LP, red globules (42.4%), with patchy arrangements (35.6%), and Wickham’s striae (94.9%) were the most common findings noted. A hem-like pattern was observed in 70% of cases of lichen planus pigmentosus. Arboriform vessels was the most common vascular morphology in lichen planopilaris. Hyperkeratosis (86.4%), lichenoid infiltrate (100%), and perivascular infiltrates (78.0%) were common histopathological findings noted in classic LP. Atrophy (80.0%) was the most common finding in LP pigmentosus. Wickham's striae and grey-blue dots on dermatoscopy correlated with hypergranulosis and pigmentary incontinence on histopathology, respectively, in cases of classic LP. Wickham's striae on dermatoscopy correlated with hypergranulosis on histopathology in cases of hypertrophic LP. Perifollicular scales on dermatoscopy correlated with follicular plugging on histopathology of lichen planopilaris. Conclusion: Most variants of Lichen planus have characteristic findings on dermatoscopy. Wickham's striae can be considered a unique finding of LP, seen in almost all cases of Classic LP. Grey-blue dots on dermatoscopy correlate with pigmentary incontinence on histopathology in classic LP and lichen plano pilaris; Wickham's striae on dermatoscopy correlates more with hypergranulosis than with hyperkeratosis on histopathology in cases of classic LP and hypertrophic LP. Dermatoscopy can act as a link between clinical and histopathological findings and can obviate the need for a biopsy.