Prospective evaluation of dermoscopic changes in hypertrophic lichen planus following intralesional steroid therapy in skin of color

Objectives: To evaluate dermoscopic changes in hypertrophic lichen planus (HLP) following intralesional triamcinolone acetonide (ILTAC) and correlate them with disease activity and clinical improvement. Materials and Methods: A prospective observational study was conducted on 40 histopathologically confirmed HLP patients aged ≥12 years over 16 months. Patients received three ILTAC (20 mg/mL) injections every four weeks for three months. Dermoscopic assessment was performed at baseline, each follow-up, and 4 weeks after the last injection using a self-designed grading system assessing Wickham’s striae, blue-gray globules, peripheral striations, comedo-like openings, follicular plugs, red dots, erosions, crusts, and scales. Data were analyzed using the Friedman test and Wilcoxon signed-rank test, and Bonferroni correction was applied. Results: Dermoscopic features like Wickham striae, peripheral striations, comedo-like openings, follicular plugs, and scales demonstrated significant regression by the fourth visit, with a marked increase in blue-gray globules. Adverse effects included combined telangiectasia with depigmentation (17.5%), telangiectasia (12.5%), and depigmentation (10%). Conclusion: ILTAC effectively induced clinical improvement; dermoscopic markers of inflammation showed marked improvement; follicular structures showed slight resistance to treatment, while increased blue-gray globules reflected residual pigmentation.