Clinical and dermoscopic features of facial and non-facial lesions in patients with papulosquamous disorders - a cross sectional study

Abstract

Background- Papulosquamous disorders are common, heterogenous group of disorders. Dermoscopic features of various papulosquamous disorders are well-characterized. Face is not commonly involved in these conditions, when involved they present differently because facial topography is different from non-facial skin. Clinical and dermoscopic features may vary for same reason. Further, face being a cosmetically significant area, invasive biopsy for confirmation of the diagnosis cannot be performed routinely. Aims and objectives- • To study the clinical and dermoscopic features of facial and non-facial lesion in patients with papulosquamous disorders namely, plaque psoriasis, classical lichen planus, pityriasis rosea, seborrheic dermatitis and pityriasis rubra pilaris. • To correlate clinical and dermoscopic features of different papulosquamous disorders. Materials and methods- It is an hospital based cross-sectional study of 55 patients presenting with various papulosquamous disorders. Patients were subjected to detailed clinical and dermoscopic examination and categorized into plaque psoriasis, classical lichen planus, pityriasis rosea, seborrheic dermatitis and pityriasis rubra pilaris. Results- Psoriasis was most common diagnosis (65.45%), followed by lichen planus (23.64%), while pityriasis rosea (3.64%), pityriasis rubra pilaris (3.64%), and seborrheic dermatitis (3.64%) were less frequent. The mean age for psoriasis and lichen planus was 28.01 and 27.23 years, respectively. Males were more frequently affected (65.45%). 9 Docusign Envelope ID: 22E0AD42-75BC-4A18-8141-1D1A1E222BD3 Dermoscopy of psoriasis revealed site-specific variations, with a red background (52.78%) and diffuse vessel distribution (97.14%) being predominant in non-facial lesions, while facial lesions showed a pink background (50%) and patchy vessel distribution (42.31%) (p < 0.001). White scales were consistently present in both locations. In lichen planus, a violaceous pink background was most common in both facial (38.46%) and non-facial (61.54%) lesions, and Wickham striae were observed in 84.61% of cases. No significant site-specific variations were noted. Pityriasis rosea lesions showed a uniform pink background with white collarette scales and brown globules, with perifollicular scaling and hypopigmentation noted in 50% of cases. Pityriasis rubra pilaris exhibited a pinkish red background in both facial and non-facial lesions, with perifollicular scaling (100%) and diffuse white scaling (100%). Dermoscopic features were largely consistent across sites. Seborrheic dermatitis showed a pinkish background in both facial and non-facial lesions, whitish scales (100%) being the predominant features. Conclusion- Dermoscopic analysis revealed significant site-specific differences in psoriasis, while lichen planus, PRP, PR, and SD displayed more consistent features across facial and non facial lesions. Dermoscopy remains a valuable tool for diagnosing and differentiating papulosquamous disorders.