Conflict of interest None.
Pilot study on reflectance confocal microscopy imaging of lichen planus: a real-time, non-invasive aid for clinical diagnosis
Article first published online: 29 SEP 2011
© 2011 The Authors. Journal of the European Academy of Dermatology and Venereology © 2011 European Academy of Dermatology and Venereology
Journal of the European Academy of Dermatology and Venereology
Volume 26, Issue 10, pages 1258–1265, October 2012
How to Cite
Moscarella, E., González, S., Agozzino, M., Sánchez-Mateos, J.L.S., Panetta, C., Contaldo, M. and Ardigò, M. (2012), Pilot study on reflectance confocal microscopy imaging of lichen planus: a real-time, non-invasive aid for clinical diagnosis. Journal of the European Academy of Dermatology and Venereology, 26: 1258–1265. doi: 10.1111/j.1468-3083.2011.04279.x
Funding support Dr. Elvira Moscarella is currently supported by the Funding support from the Italian Ministry of Health Ricerca Finalizzata 2007 (C. Catricalà) and ISS-ACC (C. Catricalà).
Role of the sponsors The sponsors had no role in the design and conduct of the study; in the collection, analysis and interpretation of data; or in the preparation, review or approval of the manuscript.
Financial disclosure None declared.
- Issue published online: 10 SEP 2012
- Article first published online: 29 SEP 2011
- Received: 28 May 2011; Accepted: 30 August 2011
Background Lichen planus (LP) represents a relatively common skin inflammatory entity included in the major group of interface dermatitis. In recent years, reflectance confocal microscopy has demonstrated to be a valuable tool for the ‘in vivo’ characterization of various skin diseases with cellular level resolution. No data are currently available that uses reflectance confocal microscopy to study LP.
Observations In this study, we have investigated the clinical and confocal features of five cases of histopathologically proven LP, and we have correlated the observed features with histopathological findings. The most characteristic criterion was the presence of interface dermatitis. Papillary rims, usually visible in normal skin, were obscured by the presence of a diffuse inflammatory cells infiltrate, arranged in sheet-like structures that surrounded the junction almost completely. There was an almost total obliteration of the ring-like structures around DP, which appeared non-edged and non-rimmed. Granular cells appeared as very large, polygonal structures, with an evident grainy cytoplasm, with the transition between spinous and granular cells being clearly recognizable, and this feature corresponded to hypergranulosis in histology. The presence of inflammatory cells at the level of the epidermis was seen as round-to-polygonal bright structures in the context of a variable degree of epidermal disarray and spongiosis. Melanophages in dermis were visible as brightly refractile, plump, oval to stellate-shaped cells. Prominent round or linear dark canalicular structures corresponded to dilated blood vessels in the superficial dermis on histopathology and appeared horizontally oriented in confocal sections.
Conclusions Reflectance confocal microscopy may represent a real-time, non-invasive aid to clinical diagnosis of LP. However, it might be difficult to distinguish between different subtypes of interface dermatitis. Further research, including larger case series, will better define a possible differential diagnosis of these diseases using confocal microscopy.