Dermoscopic Features of Lichen Sclerosus et Atrophicus, Morphea, and Overlap: A Study of 50 Patients in Skin of Colour

Introduction: Morphea and extragenital lichen sclerosus (LSA) are chronic inflammatory dermatoses with overlapping clinical features, requiring invasive biopsy for confirmation. Dermoscopy, a non-invasive tool, may aid by identifying characteristic cutaneous patterns. Objectives: To study the dermoscopic features of LSA, morphea, and their overlap in histopathologically confirmed cases and describe characteristic dermoscopic patterns. Methods: This retrospective observational study was conducted in 2020-2024 in four tertiary care centres across North India. Histopathologically confirmed cases of morphea, LSA, or overlap were included. Dermoscopic evaluation was performed using hand-held dermoscope, and findings were analysed descriptively. Results: Among 90 lesions in 50 patients, 13 were genital LSA, 52 extragenital LSA, 15 morphea and 10 LSA-morphea overlap. Common dermoscopic findings in LSA included white structureless areas (96.15%; shiny 92.31%), pigment change (84.62%), reddish hue (71.15%), violaceous hue (59.62%), scaling (53.85%), dotted vessels (36.54%). Morphea showed white structureless areas (100%; dull and broad, 80%), brown structureless areas (73.33%), pigmentary change (80%), reduced eccrine openings (80%) relative absence of vessels with occasional occurrence of linear-curved vessels (13.33%). Follicular plugging was comparable in both. Overlap cases had a mix of shiny to dull white structureless areas, pigment change (80%, variable pattern), preserved eccrine openings (60%), follicular plugs (50%), vessels (dotted 50%, linear-curved 30%). Genital LSA lesions showed shiny white structureless areas (92.31%), reddish hue (76.92%), violaceous hue (61.54%). Conclusion: Recurring dermoscopic patterns were observed: shiny white structureless areas with reddish/violaceous hue, polymorphous vessels in extragenital LSA; dull white and brown structureless areas, pigment network, reduced eccrine openings in morphea; hybrid features in overlap lesions. Dermoscopy may therefore complement clinical assessment of these entities; however, prospective studies evaluating its diagnostic accuracy are needed before it can inform decisions regarding biopsy.