Dermoscopic and reflectance confocal microscopy features of lichen sclerosus

Lichen sclerosus (LS) is an uncommon chronic skin disease mostly diagnosed after clinical examination and biopsy with histopathological evaluation. In doubtful cases dermoscopy and reflectance confocal microscopy (RCM) can increase diagnostic accuracy. There are only a few papers describing features of LS in RCM [1].
A 74-year-old woman had presented for many months with a few, small (2–3 mm in diameter), whitish plaques located on the skin of the right groin. The lesions were asymptomatic and had been increasing in number in last few months. In clinical examination the longitudinal striation of the nail plates was observed. The patient suffered from Hashimoto disease. Family history was negative. The final diagnosis of LS was confirmed by biopsy with histopathological evaluation. In histopathological evaluation atrophy of the epidermis was observed. The upper dermis revealed inflammatory infiltrate with melanophages and altered collagen bundles.
Dermoscopy of skin lesions revealed numerous whitish, well demarcated areas with yellow comedo-like structures and a few linear vessels (fig. 1).
Reflectance confocal microscopy of the epidermis revealed highly reflective stratum corneum. The horizontalized invaginations filled by keratin in stratum granulosum were detected (fig. 2). Dermo-epidermal junction was disturbed. Altered collagen bundles and inflammatory cells were observed in the upper dermis (fig. 3).
Lichen sclerosus is an uncommon chronic skin disease which affects mostly women over 50 years of age. Sometimes LS appears before puberty. The etiopathology of the disease in still unknown. The clinical examination of advanced LS with multiple plaques allows to make the final diagnosis. Sometimes the ink test which enhances follicular plugs may support the diagnosis of LS especially in children [2]. The single plaque can cause diagnostic difficulties. Dermoscopic features of LS were previously described [3]. They showed well-demarcated, whitish homogenous areas with yellow circles, corresponding to comedo-like openings.
Reflectance confocal microscopy seems to be useful in differential diagnosis with morphea or vitiligo.
Lacarrubba et al. was first to describe LS in RCM [1]. Round dark structures containing bright amorphous material in the epidermis, some of them horizontalized in stratum granulosum were observed [1]. The upper dermis revealed inflammatory cells and coarse collagen bundles. In the case presented in...


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