Dermoscopic Features of Vulvar Lichen Sclerosus in the Setting of a Prospective Cohort of Patients: New Observations

Abstract

Objective: Dermoscopic features of vulvar lichen sclerosus (VLS) were investigated in order to determine both vascular and non-vascular features of this disease. Materials and Methods: Dermoscopic images of 35 patients affected with histopathologically confirmed VLS were evaluated for the presence of predefined morphological criteria. Results: On dermoscopy, VLS lesions exhibited very sparse vessels, mainly linear, without a specific arrangement. Dotted vessels were observed mostly in the early stage of the disease. Patchy, structureless areas, whitish to white-yellowish to pink-whitish in colour over a diffuse whitish background, were a distinctive and constant dermoscopic feature. Grey-blue dots, usually with a characteristic peppered arrangement, corresponding to dermal melanophages, were also frequently seen. Comedo-like openings and scales were observed, as well as peculiar structures like ice slivers, not identified by histological examination. Conclusion: Our findings show that VLS exhibits characteristic dermoscopic patterns that can aid in its clinical diagnosis.

Clinical and dermoscopic changes of vulvar lichen sclerosus after topical corticosteroid treatment

“…Structures like ice slivers, presenting linear or triangular or lanceolated shape, were observed inside the whitish areas in four patients. On the basis of our previous study, their histological correspondence is not clear . These dermoscopic features were less observable after treatment, although without significant difference in mean scores.…”

“…On the contrary, gray-blue dots, arranged in a typical peppering pattern, did not change in a significant way after treatment compared with baseline. In a previous study, we found that gray-blue peppering corresponds to melanophages displaced in the upper dermis and at perifollicular site, as a consequence of the inflammatory process, 7 and is observable also in lichen planus. 10 Based on our findings, peppering is not affected by the application of corticosteroids.…”

“…As regards the dermoscopic parameters, mean score referring to vessels significantly increased after treatment when compared with baseline. On the other hand, mean scores of both patchy, structureless, whitish areas and whitish background, which have been found to be dermoscopic hallmarks of VLS, had decreased significantly in the 12‐week image captures. These findings may mirror the marked decrease of hyalinization of dermal collagen, which was found to be a relevant treatment effect .…”

“…Yellow comedo‐like openings correlate on histology to dilated infundibula with follicular cornified plugging and are quite a common dermoscopic finding not only in extragenital LS but also in vulvar lesions . After treatment, both the number of patients presenting comedo‐like openings and their mean scores decreased with respect to baseline, but without statistical significance.…”

Combining topical tretinoin with mometasone furoate in the treatment of vulvar lichen sclerosus: Results of dermoscopic assessment

“…Considering the dermoscopic variables addressed in this analysis in detail, mean vessel scores significantly increased after treatment in the whole population as well as in each treatment group. On the contrary, mean scores of both patchy, structure‐less, whitish areas and whitish background, which represent two dermoscopic hallmarks of VLS (Borghi et al, , Dermatology; Larre Borges et al, ), had decreased significantly at treatment completion when compared with baseline (Figure ). All together, these relevant dermoscopic changes probably reflect the decrease of dermal hyalinization and sclerosis induced by corticosteroid treatment (Dalziel et al, ), as previously hypothesized.…”