Clinical, Epidemiological, and Dermoscopic Features of Different Clinical Variants of Cutaneous Lichen Planus in the Indian Population: A Prospective Observational Study

TL;DR

This study examines the clinical and dermoscopic features of different types of lichen planus in an Indian population to improve diagnosis.

Contribution

The study provides a detailed analysis of dermoscopic features specific to different cutaneous lichen planus variants in the Indian population.

Findings

Classical lichen planus was the most common variant, with Wickham’s striae as the most frequent dermoscopic finding.

Pigmentation patterns varied significantly among different lichen planus variants, aiding in their differentiation.

Dermoscopic evaluation combined with clinical history is crucial for diagnosing classical and atypical lichen planus variants.

Abstract

Introduction: Lichen planus (LP) is a distinct clinical entity that commonly affects the skin, hair, nails, and mucous membranes. Multiple clinical variants of LP with varying morphologies have been documented. This study aimed to analyze the clinical, epidemiological, and dermoscopic features of different variants of cutaneous LP in the Indian population.

Methods: This prospective observational study was conducted at a tertiary care hospital from January 2021 to August 2022. A total of 50 patients with a confirmed diagnosis of cutaneous LP were included. Demographic details, including age, disease duration, symptoms, and family history, were recorded.

Results: Among the 50 patients, 30 (60%) were female and 20 (40%) male, with an age range of 8-65 years (mean age: 37 ± 14 years). Classical LP was the most common variant observed (26 cases, 52%), followed by lichen planus hypertrophicus (LPH) in eight cases (16%) and eruptive LP in six cases (12%). Wickham’s striae (WS) was the most common dermoscopic finding in classical LP (observed in 23 cases, 88.5%), but was absent in LPH, actinic LP, and lichen planus pigmentosus (LPP). The most frequent pigmentation patterns in classical LP were diffuse dots and diffuse globules, seen in three cases (11.5%). Pigmentation patterns were more variable in LPH and actinic LP. The background color was pink in classical and eruptive LP, and brownish in LPH, actinic LP, and LPP. It showed mixed shades in annular atrophic LP. No significant differences in demographic parameters were noted among the different variants.

Conclusion: WS was the most consistent dermoscopic feature in cases of classical cutaneous LP and can assist physicians in diagnosis. Detailed dermoscopic evaluation, combined with a comprehensive clinical history, is essential for diagnosing classical and atypical LP variants and differentiating them from clinically similar conditions. This approach offers important clues regarding the underlying histopathology.

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