Histopathological study of lichenoid dermatoses pattern at tertiary care hospital

Background: Lichenoid dermatoses are a heterogeneous group of inflammatory skin disorders with overlapping clinical features and a characteristic lichenoid tissue reaction. Histopathology is crucial for confirming the diagnosis and distinguishing subtypes and mimickers. Aims and Objectives: This study aimed to evaluate the clinicohistopathological spectrum of lichenoid dermatoses, correlate clinical findings with the histopathological diagnosis, and identify features useful in differentiating them from mimicking disorders. It also analyzed the frequency and distribution of lichen planus (LP) variants and other lichenoid conditions in the study population. Materials and Methods: A prospective observational study was conducted on clinically suspected cases of lichenoid dermatoses. Detailed clinical examination and skin biopsies were performed. Hematoxylin and eosin-stained sections were evaluated, and clinicopathological correlation was established. Data were analyzed using the Statistical Package for the Social Sciences software. Results: Clinicopathological concordance was observed in 66% of cases, discordance in 12%, and histopathology alone established diagnosis in 22%. Classical LP and discoid lupus erythematosus were the most frequent diagnoses. Key histopathological features included basal cell degeneration, band-like lymphocytic infiltrate, pigment incontinence, and hypergranulosis. Variants such as lichen nitidus and LP pigmentosus showed excellent concordance. Histopathology also identified non-lichenoid mimickers, including psoriasis, chronic dermatitis, and mycosis fungoides. Conclusion: Clinicopathological correlation is essential in diagnosing lichenoid dermatoses due to overlapping clinical features. Histopathology enhances diagnostic accuracy, aids in identifying specific variants, and differentiates lichenoid dermatoses from mimicking skin disorders.