Abstract
Dermoscopy, a non-invasive technique for cutaneous diagnosis is being increasingly studied in various disorders of the skin, nails and scalp. However, it has been under-utilized for the diagnosis and characterization of mucosal disorders. The dermoscopic characterization of cutaneous lichen planus and its variants has been well documented with Wickham’s striae constituting the hallmark of the condition. However, the dermoscopic features of oral lichen planus with hand-held or videodermoscopy remain to be elucidated. We present the case of a young adult man who presented with asymptomatic white lacy lesions over a bluish-black background over the tongue, patchy hyperpigmentation of the buccal mucosae and gingivae, and longitudinal melanonychia involving some nails. History of intake of any drugs preceding the lesions, smoking, chewing of betel nut and dental implants was negative. Family history was non-contributory. There were no cutaneous lesions suggestive of lichen planus. Mucoscopy (dermoscopy of the mucosa, oral in this case) and onychoscopy were done followed by biopsy from the tongue that confirmed the diagnosis of lichen planus. Oral mucoscopy of the tongue revealed a tri-colored pattern with structureless veil-like grey-white areas (modified Wickham’s striae), well-demarcated red glossy erosions, and violaceous-to-brown clods. Additionally, vascular pattern of dotted and linear to curved vessels along the borders of leukoplakia-like areas and erosions were observed. Onychoscopy confirmed lichen planus-associated melanonychia. Dermoscopy also proved useful in conveniently ruling out other disorders typified by mucosal and nail pigmentation such as Laugier Hunziker syndrome and drug-induced changes. Although direct oral microscopy has been used in defining features of oral lichen planus, to the best of our knowledge this case is the first report on mucoscopy or dermoscopy of oral lichen planus
Highlights
Dermoscopy has unleashed opportunities of exploring structures and features of the skin invisible to the unaided eye
Inflammoscopy, i.e. dermoscopy of inflammatory dermatoses has sufficiently advanced to the point of facilitating dermoscopic differentiation between plaque psoriasis, eczema and pityriasis rosea[1]
Wickham striae (WS) characterized by white crossing streaks are the dermoscopic hallmark of cutaneous LP1–4
Summary
Dermoscopy has unleashed opportunities of exploring structures and features of the skin invisible to the unaided eye. Case details A 19-year-old Indian gentleman was evaluated for asymptomatic patchy pigmentation over multiple finger and toe nails, the tongue, and buccal cavity, noticed eighteen months back. There was no history of preceding trauma, drug intake, soreness of mouth, or dental procedures or amalgam filling. He denied addictions like smoking or chewing of betel nut or tobacco. The dorsum of the tongue revealed violaceous to dark grey discoloration extending onto the ventral surface, interspersed with white reticular lesions and focal tiny bright red erosions (Figure 1). Buccal mucosae revealed brown colored macules with focal presence of white reticular lesions. Examination of nails revealed longitudinal melanonychia of multiple fingers and toe nails (Figure 3). Relevant hematological and biochemical investigations ruled out hepatitis, dyslipidemia, diabetes and thyroid disorder
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