10.5826/dpc.1301a45
text/xml
2160-9381
2481
en
Pavithra Ayyanar
https://creativecommons.org/licenses/by-nc/4.0
Dermatology Practical & Conceptual
pigmentation
Preliminary Dermoscopic Features of Discoid Lupus Cheilitis in Eight Patients of Skin Of Color
Text.Serial.Journal
https://dpcj.org/index.php/dpc
Research Letter
2023-01-31
2022-03-21
2023-01-31
2023-03-01
e2023045
Dermatol Pract Concept
Pavithra Ayyanar
2023/01/31
10.5826/dpc.1301a45
e2023045
Department of Pathology, AIIMS, Bhubaneswar, India
2160-9381
pigmentation
en
e2023045
Neema S, Sandhu S, Kashif AW, Sinha P, Kothari R, Radhakrishnan S. Dermoscopy of lip lichen planus-a descriptive study. Dermatol Pract Concept. 2020;10(4):e2020076. DOI: 10.5826/dpc.1004a76. PMID: 33150022. PMCID: PMC7588155.
Preliminary Dermoscopic Features of Discoid Lupus Cheilitis in Eight Patients of Skin Of Color
https://dpcj.org/index.php/dpc/article/download/2481/1937
Preliminary Dermoscopic Features of Discoid Lupus
     Cheilitis in Eight Patients of Skin of Color
                   Biswanath Behera1, Rashmi Kumari2, BH Srinivas3, Pampa Ch Toi3,
                                Debasis Gochhait3, Pavithra Ayyanar4


1 Department of Dermatology, and Venereology, AIIMS, Bhubaneswar, India
2 Department of Dermatology, Venereology and Leprology, JIPMER, Puducherry, India
3 Department of Pathology, JIPMER, Puducherry, India
4 Department of Pathology, AIIMS, Bhubaneswar, India



Key words: cheilitis, dermoscopy, lupus, pigmentation
Citation: Behera B, Kumari R, Srinivas BH, Ch Toi P, Gochhait D, Ayyanar P. Preliminary Dermoscopic Features Of Discoid Lupus Cheilitis
In Eight Patients Of Skin Of Color. Dermatol Pract Concept. 2023;13(1):e2023045. DOI: https://doi.org/10.5826/dpc.1301a45
Accepted: September 14, 2022; Published: January 2023
Copyright: ©2023 Behera et al. This is an open-access article distributed under the terms of the Creative Commons Attribution-
NonCommercial License (BY-NC-4.0), https://creativecommons.org/licenses/by-nc/4.0/, which permits unrestricted noncommercial use,
distribution, and reproduction in any medium, provided the original authors and source are credited.
Funding: None.
Competing Interests: None.
Authorship: All authors have contributed significantly to this publication.
Corresponding Author: Rashmi Kumari, M.D., Associate Professor, Dept. of Dermatology, Venereology and Leprology, JIPMER,
Puducherry, Pin-605006. Phone no- 09489692199, E-mail: rashmi.sreerag@gmail.com




Introduction                                                                  Cheilitis results from a vast group of disorders ranging
                                                                         from simple lip licking to malignant neoplasms, such as
Discoid lupus cheilitis (DLC) is a spectrum of discoid lupus             squamous cell carcinoma (SCC). Morphologically DLC can
erythematosus (DLE) presentation that can occur in associ-               be small papules, discoid plaques, or can diffusely involve
ation with cutaneous lesions. Dermoscopic features of DLC                either of the lips. Different morphological variations like
are sparsely reported [1,2].                                             dyspigmentation, erosion, keratotic, atrophic, and rare hy-
                                                                         pertrophic subtypes have been described. Early diagnosis is
Case Presentation                                                        essential as it can cause significant lip disfigurement and can
                                                                         rarely progress to SCC [3]. The diagnosis can be challenging
All eight patients in our series were female. They belonged to           in the absence of other mucocutaneous lesions of DLE.
Fitzpatrick skin phototypes IV and V. The clinical and der-                   The dermoscopic features, homogenous purplish-white,
moscopic details of all the patients are mentioned in Table 1.           ivory-white to reddish-white areas, brown to blue-gray
One case tested positive for antinuclear antibody by immu-               dots, globules, and peppering, and polymorphous vascular
nofluorescence method (2+). The pathological features in all             pattern, observed by us are the direct reflection of the un-
the cases were consistent with DLC. Direct immunofluores-                derlying pathology of discoid lupus (Figures 1 and 2). The
cence (single case from the lip and four patients from skin              white color corresponds to the hyperkeratosis with or with-
lesion) showed linear deposition of IgG, IgM, IgA, and, or               out acanthosis, the red color to the increased vascularity, the
C3 along the basement membrane zone.                                     brown to brown-gray dots and globules to melanin in the



Research Letter | Dermatol Pract Concept. 2023;13(1):e2023045                                                                         1
    Table 1. Clinico-demographic and dermoscopic features of eight cases of discoid lupus cheilitis.
           Parameters                            Demographic, clinical and dermoscopic features (number)
 Demographic characteristics         1. Age: 29-56 years
                                     2. Gender: Female (8)
 Clinical characteristics            1. Location of cheilitis
                                        i. Lower lip (7)
                                        ii. Both the lips (1)
                                     2. Morphology of cheilitis
                                        i. Eroded plaque surrounded by brown, gray, or violaceous pigmentation
                                             with/without crusting (4)
                                        ii. Erythematous to violaceous scaly plaques surrounded by violaceous to brown
                                             pigmentation (2)
                                        iii. Atrophic plaque surrounded by gray-brown pigmentation (2)
                                     3. Associations
                                        i. Cutaneous DLE (3)Verrucous DLE (1)
                                        ii. Eyelid DLE (1)
 Dermoscopic characteristics         1. Scales (7)
                                        i. Color
                                            • White (7)
                                            • Yellow (1)
                                        ii. Distribution (could not be evaluated due to the use of immersion fluid)
                                     3. Vessels (8)
                                        i. Morphology
                                            • Linear (8)
                                            • Linear curved (hairpin) (7)
                                            • Linear vessels with branches (2)
                                            • Dotted (0)
                                        ii. Distribution
                                            • Uniform (2)
                                            • Clustered (2)
                                            • Peripheral (4)
                                            • Reticular (0)
                                            • Unspecific (1)
                                     3. Follicular or eccrine findings:
                                        Follicular plugging at the mucocutaneous junction (1)
                                         a. Other structures:Homogenous area
                                            i. Ivory-white homogenous area (6)
                                            ii. Reddish-white homogenous area (5)
                                            iii. Purplish-white homogenous area (4)
                                            iv. Peripheral irregular brown-gray to blue-gray structureless area (7)
                                        b. Dots, globules, fine and coarse peppering (8)
                                            i. Color: Brown, brown-gray to blue-gray
                                            ii. Arrangement
                                                 • Clustered (6)
                                                 • Diffuse (3)
                                         c. Lines
                                            i. Brown to blue-gray radial lines (7)
                                            ii. Peripheral purplish-white radial striations (6)
                                        d. Erosion (4)
                                         e. Crust (5)
                                         f. Blood spot (2)

DLE = discoid lupus erythematosus.



stratum corneum and/or epidermis, blue-gray dots and glob-       brown to blue-gray dots, globules, and peppering were dis-
ules to the dermal melanin incontinence and melanophages,        tributed diffusely or in clusters. The polymorphous vascular
and the vascular structures to the dilated dermal vessels.       pattern included linear, linear curved, and linear vessels with
Other features noted were erosion, scales, and crust. The        branches. The observed vessels tortuosity and the absence



2                                                                    Research Letter | Dermatol Pract Concept. 2023;13(1):e2023045
Figure 1. (A) Erythematous scaly plaque on the lips surrounded by a violaceous rim. (B) Dermoscopy shows purplish-white to ivory-white
homogenous area, blue-gray radial lines (blue arrow), and linear (red arrow) vessels. (C) Linear vessels (blue arrow). (D) Ulcerated plaque is
surrounded by violaceous pigmentation. A small atrophic papule on the upper lip. (E) Dermoscopy shows reddish-white homogenous area.
(F) Clustered brown dots (blue arrows) and tortuous vessels (red arrow). G) Linear atrophic scaly plaque with peripheral violaceous pigmen-
tation. (H) Dermoscopy shows white scales and purplish-white radial striations (blue arrow). (I) Linear brown-gray radial lines (blue arrow).
(J) Ulcerate and crusted plaque. (K) Dermoscopy shows peripheral brown-gray radial lines (blue arrow). (l) Reddish-white homogenous area
(blue arrow) and linear vessels (red arrow).



of dotted vessels were other notable features. There was no              plugging at the mucocutaneous junction. This particular fea-
difference in dermoscopic features relating to the duration              ture may favor DLC diagnosis as it is commonly observed in
of the lesions.                                                          cutaneous DLE.
    Also, we observed two new dermoscopic features in                        Dermoscopic features described for labial DLE are white
DLC, brown to blue-gray radial lines and peripheral pur-                 structureless areas, scales, erosion, brown pigment spots, tel-
plish-white radial striations. A case of actinic cheilitis re-           angiectasia, and bleeding spots [1]. An isolated case from In-
ported having peripheral, white-colored projections. The                 dia had a pink background, whitish to yellowish scales, white
role of dermoscopy in diagnosing DLC needs to be evalu-                  structureless areas, blood spots, telangiectasia, irregular ves-
ated in larger studies [4]. In one case, we observed follicular          sels, and peripheral grayish‑black dots [2]. The dermoscopic



Research Letter | Dermatol Pract Concept. 2023;13(1):e2023045                                                                               3
Figure 2. (A) Atrophic crusted plaque. (B) Dermoscopy shows purplish-white homogenous area (blue arrow), white scale, crust, and linear
and linear curved vessels. C) Blue-gray peppering (arrow). D) Erythematous to violaceous plaque. Inset showing discoid lupus erythematosus
plaque on the hand. (E) Dermoscopy shows blue-gray radial lines (blue arrow) over an ivory-white homogenous area. (F) Clustered to diffuse
blue-gray dots and peppering over the ivory-white homogenous area. (G) Eroded plaque surrounded by a violaceous rim. (H) Dermoscopy
shows purplish-white homogenous area, brown dots (red arrow) and peppering, and linear vessels (blue arrow). (I) Note the tortuous vessels
(blue arrow). (J) Eroded plaque over the lower lip. (K) Dermoscopy shows reddish-white homogenous area (arrow). (L) Ivory-white (blue
arrow) to reddish-white homogenous area with blue-gray radial lines (red arrow).




features described for lip lichen planus, a closest differential       Conclusions
of DLC, are Wickham striae, ulcer, brown to blue-gray dots,
globules, and peppering, scales, linear, hairpin and dotted            In conclusion, we describe the preliminary dermoscopic fea-
vessels [5].                                                           tures of DLC in eight patients with skin of color. The com-
                                                                       mon dermoscopic features were homogenous purplish-white,
                                                                       ­ivory-white to reddish-white areas, brown to blue-gray dots,
                                                                       globules, and peering along with a polymorphous vascular
                                                                       pattern.




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Research Letter | Dermatol Pract Concept. 2023;13(1):e2023045                                                                            5
