THE DIAGNOSTIC SIGNIFICANCE OF DERMATOSCOPY IN VARIOUS FORMS OF LICHEN PLANUS

Abstract

Relevance. Lichen planus (LP) is a heterogeneous immune-inflammatory disease with pronounced clinical polymorphism, which considerably complicates timely diagnosis and the differentiation of its forms. Traditional biopsy remains the «gold standard», but its invasiveness and limited applicability in mucosal lesions require the development of non-invasive methods. Dermatoscopy, which makes it possible to visualise subclinical signs of inflammation, pigmentation and structural changes, is becoming a key instrument in the early diagnosis of LP. The insufficient standardisation of dermatoscopic criteria and their variability in different forms of the disease determine the need for further study of dermatoscopic patterns in order to increase diagnostic accuracy and optimise the tactics of the clinical management of patients. Aim of the study. To assess the diagnostic significance of dermatoscopy and to determine the specific dermatoscopic signs of the various clinical forms of lichen planus (LP). Materials and methods. The study included 84 patients with clinically confirmed LP. Clinical examination, digital dermatoscopy (HandyScope, DermLite DL4), assessment of dermatoscopic patterns according to the IDS criteria and morphological verification of the diagnosis in 42 patients were carried out. Statistical analysis included χ² and the t-test (p<0.05). Results. Pronounced differences in dermatoscopic patterns between the clinical forms of LP were revealed. Wickham's striae were registered in 94.7 % of patients with the papular form and in only 20 % with the pigmented form; in the other forms this sign was absent. Pigmentation of the «peppering» type and diffuse dark inclusions were noted in the majority of patients with the pigmented (100 %), follicular (71 %) and papular (71 %) forms. The erosive-ulcerative form was characterised by a pronounced vascular architecture. The data obtained demonstrate the high specificity of dermatoscopic signs in the diagnosis of the various forms of LP. Conclusion. Dermatoscopy is a highly informative non-invasive method of visualising structural changes in LP. The identified patterns make it possible to standardise diagnosis, to improve the differentiation between clinical forms and to reduce the need for skin biopsy, especially in typical and well-visualised cases. Dermatoscopy should be regarded as a first-line method in the diagnosis of lichen planus.