Agreement Between Dermoscopic and Histopathological findings in Diagnosing Cutaneous Lichen Planus

Abstract

Background Lichen planus is an inflammatory & immune mediated disorder. It commonly affects skin, mucosea, hair follicles & nails. It affects all races in all parts of the world. It is usually diagnosed clinically. Biopsy of skin lesions is needed at times for accurate diagnosis, which is not only invasive but also costly. Dermoscopy is a recent, non-invasive diagnostic technique, which helps in visualization of clinical patterns and subsurface skin structures, not seen by unaided eye. It can act as an alternative technique to skin biopsy for diagnosing cutaneous lichen planus. OBJECTIVE To evaluate the degree of agreement between dermoscopy and histopathology in diagnosing lichen planus Study Design Cross sectional study. Setting Department of Dermatology, Unit 1, Jinnah Hospital, Lahore. Duration of Study Study was carried out over a period of 6 months from 25th June 2018 to 25 December 2018. Sample Size A sample size of 60 is calculated at a=0.05, b=0.100 and Y=76%.[12] Sampling technique Non-probability / consecutive sampling. Material and methods In our study, 60 patients presenting to dermatology OPD with clinical suspicion of lichen planus were evaluated in a well lit room and those patients who meet the inclusion criteria were recorded. Demographic history i.e, age, gender and address was recorded. After taking informed consent, a detailed history, clinical examination and relevant investigations were done and recorded in a pre-structured proforma. All patients then were subjected to dermoscopic examination of cutaneous lesions by placing a drop of oil. Findings were recorded on proforma. The lesions examined were marked and 4 mm punch biopsy under aseptic measures were taken from the same site for histopathological examination & sent to JHL Histopathology Lab. The results of dermoscopic and histopathological examinations are recorded. Effect modifiers like age, gender, and duration of disease were addressed through stratification of data. Results Mean age of subjects was 35 years with minimum of 18 years and maximum of 58 years. Out of total 60 patients, 56.6% female and 43.3% were male. Duration of disease was from 1 month to 2.5 years, 56.6% subjects had disease duration of less than 6 months and 43.4% had more than than 6 months. Dermoscopy and histopathology was performed on all 60 patients. Out of 57 subjects, 94.7% who were diagnosed on histopathology were also diagnosed by dermoscopy and 5.3% were not diagnosed by dermoscopy. Kappa statistics showed a substantial agreement between two diagnostic modalities. (X2=29.697, p=.000). (k= .700 p=.000). Conclusion The study concluded that dermoscopy is as effective as hitopathology in diagnosis of cutaneous lichen planus and there is a substantial agreement between these two diagnostic modalities. Keywords Cutaneous lichen planus, dermoscopy, histopathology.

Keywords

• Cutaneous lichen planus, dermoscopy, histopathology.