10.5826/dpc.1301a24
text/xml
2160-9381
2487
en
Soumiya Chiheb
https://creativecommons.org/licenses/by-nc/4.0
Dermatology Practical & Conceptual
case series 
Dermoscopy of Annular Atrophic Lichen Planus on a Dark Phototype: A Case Series    
Text.Serial.Journal
https://dpcj.org/index.php/dpc
Research Letter
2023-01-31
2022-03-23
2023-01-31
2023-02-27
e2023024
Dermatol Pract Concept
Soumiya Chiheb
2023/01/31
10.5826/dpc.1301a24
e2023024
Faculty of Medicine, Mohammed VI University of Health Sciences (UM6SS), Casablanca, Morocco
2160-9381
case series 
en
e2023024
Reich HL, Nguyen JT, James WD. Annular lichen planus: a case series of 20 patients. J Am Acad Dermatol. 2004;50(4):595‑599. DOI: 10.1016/j.jaad.2003.08.011. PMID: 15034510.
Dermoscopy of Annular Atrophic Lichen Planus on a Dark Phototype: A Case Series    
https://dpcj.org/index.php/dpc/article/download/2487/1910
       Dermoscopy of Annular Atrophic Lichen Planus
           on a Dark Phototype: A Case Series
                              Awatef Kelati1,2,3,4, Mouna Rimani5, Soumia Chiheb1


1 Dermatology Department, Cheikh Khalifa University Hospital. Faculty of Medicine, Mohammed VI University of Health Sciences (UM6SS),
  Casablanca, Morocco
2 Member of the International Dermoscopy Society Task Force of dark skin’s imaging
3 Non-invasive skin imaging group of the French Society of Dermatology
4 Non invasive skin imaging group of the Moroccan Society of Dermatology
5 Department of Pathological Anatomy Hassan, Rabat, Morocco



Key words: dermoscopy, annularity, atrophic lichen planus, dark skin, case series
Citation: Kelati A, Rimani M, Chiheb S. Dermoscopy of Annular Atrophic Lichen Planus on a Dark Phototype: A Case Series.
Dermatol Pract Concept. 2023;13(1):e2023024. DOI: https://doi.org/10.5826/dpc.1301a24
Accepted: May 26, 2022; Published: January 2023
Copyright: ©2023 Kelati 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: Kelati Awatef, Dermatology Department, Cheikh Khalifa International University Hospital. Faculty of Medicine,
Mohammed VI University of Health Sciences (UM6SS), Casablanca, Morocco. Email: akelati@um6ss.ma, awatkelati@gmail.com




Introduction                                                             (the mother and her 2 children). No specific history has
                                                                         been noted.
Annular atrophic lichen planus (AALP) is considered one of                    All patients presented itchy papules, and plaques of
the rarest morphological variants of LP [1], it affects usually          ­annular morphology with a hyper-pigmented-atrophic cen-
the limbs, penis, scrotum or intertriginous areas [2]. Histo-            ter and a violaceous raised border, individual lesions ranged
logically, AALP is characterized by an extensive elastolysis             in size from 0.5 to 2 cm, the eruptions were located on the
caused by lymphatic cells [3].                                           upper limbs in 2 adult patients, and generalized on the trunk,
    Dermoscopic findings of AALP have not been well de-                  the back and the limbs in three patients from the same fam-
scribed. The aim of this report is to investigate dermoscopic            ily. None of the patients had oral mucosal, vulval, scalp, or
features of this rare variant of LP in dark skinned patients.            nail lesions.
                                                                              Upon dermoscopic analysis, we observed mixed features
                                                                         of grayish-white annular and reticular Wickham Striae (WS) at
Case Presentation
                                                                         the periphery of the lesions, and clustered brown-grey dots on
Five dark-skinned patients (phototype V) with AALP were                  a light brown background in the center (black-hole ­pattern).
included in this case series. Patients ranged in age from                In active lesions, dotted vessels around WS were noticed on a
7 to 35 years (median age was 22.2 years), there was a                   background of erythema. In late lesions, we observed hetero-
male predominance (3/5 patients), 3 of these patients were               geneous granular pigmented dots on and around WS, white
adults, and 2 of them were children from the same family                 starburst scar-like areas were noticed in some spots (Figure 1).



Research Letter | Dermatol Pract Concept. 2023;13(1):e2023024                                                                          1
Figure 1. Pigmented annular atrophic lichen planus (AALP). (A,B) Clinical pictures of eruptive AALP. (C) Localized AALP on the limbs and
the axilla. (D-F) Dermoscopy images showing grayish-white annular and reticular Wickham striae (WS) at the periphery of the lesions, and
clustered brown-gray dots on a light brown background in the center (black-hole pattern). (G) Active lesions: dotted vessels around annular
WS on a background of erythema. (H,I) Late inactive lesions: heterogeneous granular and arciform pigmented dots and globules on and
around WS (I), white starburst scar-like areas (H).



    Histopathology was performed in adult patients, clas-              papillary dermis (Figure 2). Based on these findings, the
sic histopathology of lichen planus was observed at the                ­diagnosis of AALP was reached. Adult patients were treated
periphery of the lesion, with hair damage in some areas,               with topical steroids and oral doxycycline, oral erythromy-
while in the center, the epidermis was atrophic and flattened,         cin was prescribed for the two children. Four of them went
with loss of rete ridges. Melanophages were noticed in the             into complete remission, while in one patient with eruptive



2                                                                           Research Letter | Dermatol Pract Concept. 2023;13(1):e2023024
Figure 2. Pigmented annular atrophic lichen planus. Histopathology (H&E). (A) Magnification x 50) at the periphery of the lesion, band-like
inflammatory lichenoid infiltrate intimately linked to the dermo-epidermal interface. (B) (x100). Hair damage by the inflammatory infiltrate. (C)
(x400) and (D) (x 200) At the center of the lesion, lichenoid infiltrate with basal apoptotic bodies and melanophages in the superficial dermis.



AALP, two recurrences occurred, and oral steroids were then               black hole pattern was the predominant pattern and vascu-
prescribed with a good evolution.                                         lar structures were noticed around WS on a background of
                                                                          erythema in active early lesions. In addition, we described
                                                                          dermoscopic findings of inactive late lesions of AALP such as
Conclusions
                                                                          heterogeneous granular pigmented dots and white starburst
The role of dermoscopy in diagnosing AALP in dark skin                    scar-like areas.
was highlighted in one case report [2] and one study [4],                     One the other hand, in the previous case report [2],
the black hole pattern that was reported in this study was                another different dermoscopic pigmented pattern was
mixed with other patterns of LP, also the authors reported                reported, which is diffuse fine peppering or perifollicu-
an absence of vascular features. While, in our case series, the           lar pigmentation, this may be due to the different clinical



Research Letter | Dermatol Pract Concept. 2023;13(1):e2023024                                                                                  3
presentation in that case as annular macules without a raised     References
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                                                                  5. Reich HL, Nguyen JT, James WD. Annular lichen planus: a case
We are indebted to Constance Renton and Saadi Wafae for                series of 20 patients. J Am Acad Dermatol. 2004;50(4):595‑599.
their help in the English editing of this manuscript.                  DOI: 10.1016/j.jaad.2003.08.011. PMID: 15034510.




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