Dermoscopy of Active Lichen Planus

Abstract

T HE LESIONS ARE FROM THE LOWER BACK OF a 34-year-old man (Figure 1), the wrist of a 45-year-old woman (Figure 2), and the leg of a 51-year-old woman (Figure3). All 3 lesions reveal a similar dermoscopic finding: a polymorphic pearly whitish structure that corresponds to the Wickham striae (WS), pathognomonic of lichen planus. Mature, active violaceous papules and plaques of lichen planus show characteristic rounded, arboriform, reticular, or annular WS. The WS border shows projections of varying sizes, from thin spikes (comblike appearance) to broad arboriform ramifications, that may come together in networks. Prominent linear vessels are usually intermingled with the WS border projections (radial capillaries). The histologic correlate of WS seems to be a compact orthokeratosis above the zones of wedgeshaped hypergranulosis (centered around acrosyringia and acrotrichia). These cases illustrate the active stage of lichen planus lesions under dermoscopy.