Extragenital lichen sclerosus: Clinical, dermoscopic, confocal microscopy and histologic correlations

Extragenital lichen sclerosus is a chronic inflammatory dermatosis that is characterized by the presence of white papules and atrophic plaques. Both dermoscopy and confocal microscopy may be useful for in vivo noninvasive differential diagnosis, with those dermatoses showing similar clinical aspect, such as morphea. The whitish homogenous area and the comedo-like openings seen at dermoscopy correspond to the histopathologic features of epidermis atrophy, fibrosis of the upper dermis, and follicular plugging. Reflectance confocal microscopy reveals microscopic details closely correlated to histologic features: hyperkeratosis and epidermal atrophy are seen with both techniques; keratin-filled invaginations correspond to follicular plugging, and inflammatory cells correspond to the lichenoid infiltrate.