Comedo-like openings in dermoscopy: An essential diagnostic clue for lichen sclerosus, even in children Celia Horcajada-Reales, MD,a Minia Campos-Domınguez, MD,a Elena Conde-Montero, MD,a Ver onica Parra-Blanco, MD,b and Ricardo Suarez-Fernandez, PhDa Madrid, Spain
CLINICAL PRESENTATION Case 1 was a 10-year-old child who presented with multiple hyperpigmented brightening papules and plaques on the limbs and trunk (Fig 1). Case 2 was a 5-year-old child with a well delimited hypopigmented plaque on the lower eyelid.
Fig 1. Lichen sclerosus. Hypopigmented plaques on the ankle.
DERMOSCOPY APPEARANCE The dermoscopic examination of case 1 revealed a whitish plaque with comedo-like openings in the center of each lesion (Fig 2). In case 2, the dermoscopic examination revealed a reticulated whitish background with multiple comedo-like openings.1,2
Fig 2. Lichen sclerosus. Comedo-like openings in the center of the lesion.
From the Departments of Dermatologya and Histopathology,b n, Madrid. Hospital Universitario Gregorio Mara~ no Publication of this article was supported by 3Gen. Funding sources: None. Conflicts of interest: None declared. Correspondence to: Celia Horcajada Reales, MD, Department of n, c/o Dr Esquerdo, 46, Dermatology, Hospital Gregorio Mara~ no 28007, Madrid (Madrid), Spain. E-mail: [email protected].
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J Am Acad Dermatol 2015;72:S4-5. 0190-9622/$36.00 ª 2014 by the American Academy of Dermatology, Inc. http://dx.doi.org/10.1016/j.jaad.2014.03.006
J AM ACAD DERMATOL VOLUME 72, NUMBER 1
Horcajada-Reales et al S5
HISTOLOGIC DIAGNOSIS The histologic examination revealed hyperkeratosis, follicular plugging, atrophy of the epidermis with vacuolar degeneration of the basal layer, and a homogenized and edematous papillary dermis with a lichenoid mononuclear infiltrate (Fig 3). These findings were consistent with the diagnosis of lichen sclerosus.
Fig 3. Lichen sclerosus. Histologic findings. Note the epidermal atrophy, inconspicuous lichenoid changes, and follicular plugging. (Hematoxylineeosin stain; original magnification: 340.)
KEY MESSAGE Extragenital lichen sclerosus is rare in children. Moreover, if there is no genital involvement, the differentiation with other causes of atrophic plaques may be troublesome. Consequently, comedo-like openings represent an extremely valuable dermoscopic finding to avoid additional invasive diagnostic examinations.
REFERENCES 1. Garrido-Rıos A, Alvarez-Garrido H, Sanz-Mu~ noz C, Aragoneses-Fraile H, Manchado-L opez P, Miranda-Romero A. Dermoscopy of extragenital lichen sclerosus. Arch Dermatol 2009;145:1468. 2. Shim WH, Jwa SW, Song M, Kim HS, Ko HC, Kim MB, et al. Diagnostic usefulness of dermatoscopy in differentiating lichen sclerous et atrophicus from morphea. J Am Acad Dermatol 2012;66:690-1.
CLINICAL PRESENTATION Case 1 was a 10-year-old child who presented with multiple hyperpigmented brightening papules and plaques on the limbs and trunk (Fig 1). Case 2 was a 5-year-old child with a well delimited hypopigmented plaque on the lower eyelid.
Fig 1. Lichen sclerosus. Hypopigmented plaques on the ankle.
DERMOSCOPY APPEARANCE The dermoscopic examination of case 1 revealed a whitish plaque with comedo-like openings in the center of each lesion (Fig 2). In case 2, the dermoscopic examination revealed a reticulated whitish background with multiple comedo-like openings.1,2
Fig 2. Lichen sclerosus. Comedo-like openings in the center of the lesion.
From the Departments of Dermatologya and Histopathology,b n, Madrid. Hospital Universitario Gregorio Mara~ no Publication of this article was supported by 3Gen. Funding sources: None. Conflicts of interest: None declared. Correspondence to: Celia Horcajada Reales, MD, Department of n, c/o Dr Esquerdo, 46, Dermatology, Hospital Gregorio Mara~ no 28007, Madrid (Madrid), Spain. E-mail: [email protected].
S4
J Am Acad Dermatol 2015;72:S4-5. 0190-9622/$36.00 ª 2014 by the American Academy of Dermatology, Inc. http://dx.doi.org/10.1016/j.jaad.2014.03.006
J AM ACAD DERMATOL VOLUME 72, NUMBER 1
Horcajada-Reales et al S5
HISTOLOGIC DIAGNOSIS The histologic examination revealed hyperkeratosis, follicular plugging, atrophy of the epidermis with vacuolar degeneration of the basal layer, and a homogenized and edematous papillary dermis with a lichenoid mononuclear infiltrate (Fig 3). These findings were consistent with the diagnosis of lichen sclerosus.
Fig 3. Lichen sclerosus. Histologic findings. Note the epidermal atrophy, inconspicuous lichenoid changes, and follicular plugging. (Hematoxylineeosin stain; original magnification: 340.)
KEY MESSAGE Extragenital lichen sclerosus is rare in children. Moreover, if there is no genital involvement, the differentiation with other causes of atrophic plaques may be troublesome. Consequently, comedo-like openings represent an extremely valuable dermoscopic finding to avoid additional invasive diagnostic examinations.
REFERENCES 1. Garrido-Rıos A, Alvarez-Garrido H, Sanz-Mu~ noz C, Aragoneses-Fraile H, Manchado-L opez P, Miranda-Romero A. Dermoscopy of extragenital lichen sclerosus. Arch Dermatol 2009;145:1468. 2. Shim WH, Jwa SW, Song M, Kim HS, Ko HC, Kim MB, et al. Diagnostic usefulness of dermatoscopy in differentiating lichen sclerous et atrophicus from morphea. J Am Acad Dermatol 2012;66:690-1.
