Preliminary study on dermoscopic features of vulvar lichen planus: New insights for diagnosis

Background Vulvar lichen planus (VLP) may be difficult to clinically differentiate from other inflammatory vulvar diseases. To date, dermoscopic features of VLP, which could be useful for addressing diagnosis, have not been studied. Objective: dermoscopic features of VLP were investigated in order to determine both vascular and non-vascular features of this disease. Methods Dermoscopic images of 10 patients affected with histopathologically confirmed VLP were evaluated for the presence of predefined morphologic criteria. Variables mainly included vascular morphology and arrangement, presence and configuration of Wickham striae (WS), background colour. Results On dermoscopy, VLP lesions exhibited a characteristic vascular pattern over an intense red background consisting of linear (10/10, 100%), hairpin (8/10, 80.0%) and spermatozoa-like vessels (6/10, 60.0 %) arranged diffusely throughout lesions, with frequent peripheral parallel arrangement. In 4 cases, linear hairpin vessels surrounded by blue-grey pigment were arranged in a sea-anemone-like pattern (Fig. 2a’), never previously described in skin LP. WS were a distinctive and frequent (7/10, 70%) dermoscopic feature. These whitish, pearly areas presented in reticular, annular, globular, dotted/“starry sky, homogeneous, and grey-white or blue-white veil configurations, often combined. Grey-blue dotted or globular areas, frequently with a characteristic peppered arrangement were also seen. Conclusions Our findings show that VLP exhibits characteristic dermoscopic patterns that can aid its clinical diagnosis