Lichenoid keratosis, also known as lichen planus-like keratosis, is a common benign skin lesion. It often presents as a solitary, red or brown, scaly plaque on sun-exposed areas of the trunk and extremities in middle-aged and elderly individuals. The exact cause of lichenoid keratosis remains unclear but is thought to be related to an immunologically-mediated involution of precursor lesions such as solar lentigo and seborrheic keratosis.
Clinically, it can resemble a variety of skin conditions, including seborrheic keratosis, psoriasis, and even some malignant skin lesions like basal cell carcinoma and melanoma. This poses significant diagnostic challenges for dermatologists, as accurate diagnosis is crucial for determining appropriate treatment and management strategies. However, with the advent of dermatoscopy, a valuable tool in dermatological diagnosis, dermatologists now have a more effective means of distinguishing lichenoid keratosis from other similar lesions.
Why Is Dermatoscopy Important in Skin Diagnosis?
The dermatoscope is a handheld medical device that allows dermatologists to visualize skin lesions in greater detail.The IBOOLO dermatoscope consists of a magnification system and a light source that allows the physician to visualize skin microstructures that are not visible to the naked eye. Secondly, it provides a non-invasive method of examining skin lesions, avoiding the need for immediate biopsies and reducing patient discomfort. Both the IBOOLO DE-3100 and DE-4100 are capable of up to 10X magnification and feature multiple light modes-polarized light, non-polarized light, and amber light. Users can use them for naked-eye observation of skin lesions, or connect them to their phones to take videos or save pictures.
What Are the Dermatoscopic Features of Lichenoid Keratosis?
When examining lichenoid keratosis with a dermatoscope, several distinct features can be observed:
Red dots and red patches: Due to the dilation of blood vessels within the lesion, reflecting the inflammatory nature of the condition.
Blue-white structures: These may appear as small, granular blue-white globules or a blue-white network. This is thought to be related to the dense inflammatory cell infiltrate and altered skin pigmentation in the affected area.
Follicular hyperkeratosis: Characterized by small keratotic plugs in the hair follicles.
Linear and reticular patterns: Formed by the arrangement of skin structures and pigments within the lesion.
Additionally, according to a study, lichenoid keratosis is more likely than non-LPLKs to have scale and orange color. Coarse peppering and the presence of peppering as the only dermoscopic feature may further aid the identification of pigmented LPLKs.
Is It Necessary to Remove Lichenoid Keratosis?
In most cases, lichenoid keratosis is a benign skin lesion and does not require surgical removal. However, due to its clinical similarity to certain malignant lesions, some patients or even some physicians may consider biopsy or excision to confirm the diagnosis and rule out malignancy. Regarding the risk of malignant transformation, current evidence suggests that lichenoid keratosis has a very low potential for becoming cancerous. However, as with any skin lesion, regular follow-up is recommended to monitor for any changes in its appearance or characteristics. If there are any signs of suspicion, such as rapid growth, changes in color or shape, or symptoms like itching or bleeding, further evaluation and possible biopsy should be considered to ensure the lesion remains benign.
How to Make Clinical Decisions Based on Dermatoscopy Findings?
When using dermatoscopy to guide clinical decisions, dermatologists take into account the dermatoscopic features observed, the patient's medical history, and other clinical findings. If the dermatoscopic features are typical of lichenoid keratosis and there are no signs of malignancy, a diagnosis of lichenoid keratosis can often be made without biopsy. In such cases, reassurance may be sufficient, along with advice on skin care and sun protection. However, if the dermatoscopic features are atypical or there are other reasons to suspect malignancy, a biopsy may be recommended to confirm the diagnosis. The results of the biopsy will then guide the treatment plan, which may include options such as surgical excision, cryotherapy, or topical medications. The decision-making process in dermatology requires a comprehensive assessment of all available information, with dermatoscopy serving as a valuable tool in this process.
What Are the Treatment and Management Options for Lichenoid Keratosis?
The treatment and management of lichenoid keratosis depend on various factors, including the lesion's characteristics, the patient's symptoms, and the patient's preferences. For many patients with asymptomatic lichenoid keratosis, no specific treatment may be necessary other than regular monitoring. However, if the lesion is symptomatic, such as causing itching or discomfort, or if the patient is concerned about its appearance, several treatment options are available. Local therapies, including topical corticosteroids and topical retinoids, may help reduce inflammation and improve the skin's appearance. Phototherapy, which involves exposing the skin to specific wavelengths of light, can also be used to treat lichenoid keratosis in some cases. During treatment, it is important to monitor the patient's response and adjust the treatment plan as needed.