Case and Research Letter
Value of Dermoscopy in the Diagnosis and Prognostic Evaluation of Linear Pigmented Lichen Planus
Aportación de la dermatoscopia en el diagnóstico y pronóstico del liquen plano pigmentado lineal
E. Baquero Sánchez, A.I. Lorente-Lavirgen
, J. Domínguez Cruz, J. Conejo-Mir
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Servicio de Dermatología y Venereología, Hospital Universitario Virgen del Rocío, Sevilla, Spain
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Baquero Sánchez, A.I. Lorente-Lavirgen, J. Domínguez Cruz, J. Conejo-Mir" "autores" => array:4 [ 0 => array:2 [ "nombre" => "E." "apellidos" => "Baquero Sánchez" ] 1 => array:4 [ "nombre" => "A.I." "apellidos" => "Lorente-Lavirgen" "email" => array:1 [ 0 => "ariselae84@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 2 => array:2 [ "nombre" => "J." "apellidos" => "Domínguez Cruz" ] 3 => array:2 [ "nombre" => "J." "apellidos" => "Conejo-Mir" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Dermatología y Venereología, Hospital Universitario Virgen del Rocío, Sevilla, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Aportación de la dermatoscopia en el diagnóstico y pronóstico del liquen plano pigmentado lineal" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 746 "Ancho" => 995 "Tamanyo" => 300898 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">A dense band-like inflammatory infiltrate can be seen at the interface, with vacuolar degeneration of the basal layer and scattered apoptotic keratinocytes (hematoxylin and eosin, original magnification ×<span class="elsevierStyleHsp" style=""></span>10).</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">We report the case of a 63-year-old woman who presented a 3-month history of hyperpigmented and pruritic skin lesions in the lumbar region. Physical examination revealed violaceous-brown macules in a linear distribution with an italic S morphology (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). The nails and mucosas were not affected. The patient did not report using systemic or topical treatments, exposure to the sun, or trauma prior to the onset of the lesions.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">Dermoscopy revealed longitudinal pearly-white lines suggestive of Wickham striae (WS) and regressing brown macules in which there were grayish-brown dots and globules, some in a linear distribution following the outline of the WS or clustered in the depressed center of the WS (“ashy holes”) (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). Skin biopsy revealed interface dermatitis with a lymphohistiocytic infiltrate, vacuolar degeneration of the basal layer, and apoptotic keratinocytes (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>).</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">Based on the clinical, dermoscopic, and histologic findings, we made a diagnosis of pigmented linear lichen planus (LLP). A course of oral antihistamines and topical corticosteroids was prescribed, daily for the first month followed by an alternating regimen for 3 months. This produced a gradual resolution of the lesions, which left a residual postinflammatory hyperpigmentation.</p><p id="par0020" class="elsevierStylePara elsevierViewall">LLP is a condition of unknown etiology. It presents as hyperpigmented macules that usually arise in sun-exposed areas, but that are sometimes widespread.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> LLP differs clinically from classic lichen planus (LP) not only by the pigmentation, but also by its longer clinical course and the fact that the scalp, nails, and mucosas are not usually affected.<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">1–5</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">One of the peculiarities of this case is the Blaschkoid distribution in an italic S shape. A review of the literature has revealed very few reports of LLP with isolated segmental manifestations, whether in a zosteriform distribution<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a> (in which case a history of herpes zoster must be sought, as this would suggest Wolf's isotopic phenomenon<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a>) or following the Blaschko lines,<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">4,5</span></a> or with overlapping segmental manifestations,<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a> in which linear lesions are associated with widespread nonsegmental lesions, indicative of diseases with a polygenic inheritance, including LP and other common dermatoses, such as psoriasis.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">6</span></a> However, with the exception of our patient, all affected individuals have been of Middle Eastern or South American origin<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">1–5</span></a>; our patient is the first reported case of LLP in a Caucasian woman. The differential diagnosis is broad and includes linear dermatoses such as lichen striatus, inflammatory linear verrucous epidermal nevus, linear and whorled nevoid hypermelanosis, and the segmental manifestations of ashy dermatosis.<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">3,7</span></a> Differentiation from ashy dermatosis can be difficult and some authors even suggest that they are the same condition.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">7</span></a> In our case, the presence of pruritus, the absence of an erythematous border, and the histology and dermoscopy findings that included the presence of WS, led us to make a diagnosis of LLP.</p><p id="par0030" class="elsevierStylePara elsevierViewall">We believe it is important to highlight the role of dermoscopy as a useful tool for diagnosis. Whitish striae or WS are the most significant dermoscopic pattern and are considered to be pathognomic of LP.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">8</span></a> Striae of different morphologies—round, arboriform, reticular, annular—have been described.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">8</span></a> The presence of pigmentation in the form of grayish-brown dots and globules has also been described; this can coexist with WS, outlining the lesions, or grouped within the central area of those with a round morphology (ashy holes).<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">9</span></a> In more advanced stages, the WS may disappear, leaving only the pigmentation.<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">9</span></a> Vázquez et al.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a>described 3 dermoscopic patterns in LLP: dots, diffuse, and mixed; those authors suggested that the more intense the granular deposits, the slower and more persistent the course of the disease, whereas a diffuse pattern of pigmentation with an absence of globules or dots was associated with earlier resolution.<a class="elsevierStyleCrossRefs" href="#bib0095"><span class="elsevierStyleSup">9,10</span></a> In our patient we observed a mottled pattern formed by clusters of numerous brown dots and globules and, as predicted, the course clinical was slow and the condition persisted for a year after diagnosis.</p><p id="par0035" class="elsevierStylePara elsevierViewall">In conclusion, we have presented a rare case of LLP with a Blaschkoid distribution and we have described the most relevant dermoscopic features of this disease. Ever more cases like this one demonstrate the usefulness of dermoscopy not only in the diagnosis of inflammatory diseases of the skin, but also as a tool to predict the prognosis.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Baquero Sánchez E, Lorente-Lavirgen A, Domínguez Cruz J, Conejo-Mir J. Aportación de la dermatoscopia en el diagnóstico y pronóstico del liquen plano pigmentado lineal. Actas Dermosifiliogr. 2015;106:339–340.</p>" ] ] "multimedia" => array:3 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 697 "Ancho" => 996 "Tamanyo" => 106342 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Hyperpigmented linear macules with an italic S morphology in the left lumbar region.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 663 "Ancho" => 995 "Tamanyo" => 115646 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Dermoscopy: Wickham striae (arrows) together with grayish-brown dots and globules following the Wickham striae or clustered in the depressed center of these lesions in the form of ashy holes (asterisks).</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 746 "Ancho" => 995 "Tamanyo" => 300898 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">A dense band-like inflammatory infiltrate can be seen at the interface, with vacuolar degeneration of the basal layer and scattered apoptotic keratinocytes (hematoxylin and eosin, original magnification ×<span class="elsevierStyleHsp" style=""></span>10).</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0055" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Lichen planus pigmentosus" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "L.K. 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| año/Mes | Html | Total | |
|---|---|---|---|
| 2024 Noviembre | 6 | 2 | 8 |
| 2024 Octubre | 67 | 25 | 92 |
| 2024 Septiembre | 104 | 17 | 121 |
| 2024 Agosto | 90 | 51 | 141 |
| 2024 Julio | 91 | 33 | 124 |
| 2024 Junio | 70 | 38 | 108 |
| 2024 Mayo | 74 | 27 | 101 |
| 2024 Abril | 70 | 28 | 98 |
| 2024 Marzo | 67 | 32 | 99 |
| 2024 Febrero | 55 | 31 | 86 |
| 2024 Enero | 59 | 34 | 93 |
| 2023 Diciembre | 75 | 12 | 87 |
| 2023 Noviembre | 79 | 27 | 106 |
| 2023 Octubre | 83 | 28 | 111 |
| 2023 Septiembre | 58 | 29 | 87 |
| 2023 Agosto | 53 | 21 | 74 |
| 2023 Julio | 41 | 51 | 92 |
| 2023 Junio | 53 | 21 | 74 |
| 2023 Mayo | 68 | 21 | 89 |
| 2023 Abril | 44 | 25 | 69 |
| 2023 Marzo | 48 | 16 | 64 |
| 2023 Febrero | 45 | 29 | 74 |
| 2023 Enero | 48 | 30 | 78 |
| 2022 Diciembre | 62 | 48 | 110 |
| 2022 Noviembre | 40 | 22 | 62 |
| 2022 Octubre | 37 | 25 | 62 |
| 2022 Septiembre | 31 | 55 | 86 |
| 2022 Agosto | 36 | 39 | 75 |
| 2022 Julio | 24 | 27 | 51 |
| 2022 Junio | 29 | 36 | 65 |
| 2022 Mayo | 54 | 32 | 86 |
| 2022 Abril | 41 | 34 | 75 |
| 2022 Marzo | 44 | 34 | 78 |
| 2022 Febrero | 57 | 25 | 82 |
| 2022 Enero | 44 | 35 | 79 |
| 2021 Diciembre | 27 | 31 | 58 |
| 2021 Noviembre | 45 | 53 | 98 |
| 2021 Octubre | 50 | 50 | 100 |
| 2021 Septiembre | 41 | 31 | 72 |
| 2021 Agosto | 32 | 28 | 60 |
| 2021 Julio | 43 | 23 | 66 |
| 2021 Junio | 28 | 22 | 50 |
| 2021 Mayo | 34 | 18 | 52 |
| 2021 Abril | 64 | 83 | 147 |
| 2021 Marzo | 40 | 17 | 57 |
| 2021 Febrero | 49 | 33 | 82 |
| 2021 Enero | 37 | 23 | 60 |
| 2020 Diciembre | 17 | 18 | 35 |
| 2020 Noviembre | 16 | 16 | 32 |
| 2020 Octubre | 15 | 15 | 30 |
| 2020 Septiembre | 19 | 19 | 38 |
| 2020 Agosto | 19 | 30 | 49 |
| 2020 Julio | 13 | 19 | 32 |
| 2020 Junio | 28 | 30 | 58 |
| 2020 Mayo | 21 | 24 | 45 |
| 2020 Abril | 27 | 21 | 48 |
| 2020 Marzo | 22 | 28 | 50 |
| 2020 Febrero | 3 | 0 | 3 |
| 2020 Enero | 0 | 1 | 1 |
| 2019 Diciembre | 4 | 3 | 7 |
| 2019 Noviembre | 0 | 3 | 3 |
| 2019 Septiembre | 6 | 2 | 8 |
| 2019 Agosto | 0 | 1 | 1 |
| 2019 Julio | 0 | 5 | 5 |
| 2019 Junio | 2 | 11 | 13 |
| 2019 Mayo | 0 | 37 | 37 |
| 2019 Abril | 0 | 13 | 13 |
| 2019 Marzo | 2 | 11 | 13 |
| 2019 Enero | 2 | 0 | 2 |
| 2018 Diciembre | 2 | 0 | 2 |
| 2018 Noviembre | 1 | 0 | 1 |
| 2018 Octubre | 3 | 1 | 4 |
| 2018 Septiembre | 6 | 0 | 6 |
| 2018 Junio | 0 | 5 | 5 |
| 2018 Mayo | 0 | 4 | 4 |
| 2018 Abril | 0 | 4 | 4 |
| 2018 Marzo | 14 | 8 | 22 |
| 2018 Febrero | 34 | 4 | 38 |
| 2018 Enero | 74 | 8 | 82 |
| 2017 Diciembre | 38 | 12 | 50 |
| 2017 Noviembre | 34 | 8 | 42 |
| 2017 Octubre | 32 | 16 | 48 |
| 2017 Septiembre | 23 | 16 | 39 |
| 2017 Agosto | 19 | 24 | 43 |
| 2017 Julio | 25 | 29 | 54 |
| 2017 Junio | 27 | 18 | 45 |
| 2017 Mayo | 29 | 29 | 58 |
| 2017 Abril | 24 | 25 | 49 |
| 2017 Marzo | 16 | 35 | 51 |
| 2017 Febrero | 19 | 13 | 32 |
| 2017 Enero | 19 | 14 | 33 |
| 2016 Diciembre | 27 | 10 | 37 |
| 2016 Noviembre | 35 | 16 | 51 |
| 2016 Octubre | 17 | 20 | 37 |
| 2016 Septiembre | 0 | 1 | 1 |
| 2016 Agosto | 0 | 3 | 3 |
| 2016 Julio | 13 | 4 | 17 |
| 2016 Junio | 12 | 3 | 15 |
| 2016 Mayo | 11 | 1 | 12 |
| 2016 Abril | 9 | 1 | 10 |
| 2016 Marzo | 7 | 3 | 10 |
| 2016 Febrero | 11 | 2 | 13 |
| 2016 Enero | 10 | 2 | 12 |
| 2015 Diciembre | 10 | 1 | 11 |
| 2015 Noviembre | 9 | 10 | 19 |
| 2015 Octubre | 0 | 3 | 3 |
| 2015 Septiembre | 0 | 2 | 2 |
| 2015 Agosto | 0 | 6 | 6 |
| 2015 Julio | 6 | 1 | 7 |
| 2015 Junio | 6 | 10 | 16 |
| 2015 Mayo | 9 | 10 | 19 |
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