Dermatology: Practical and Conceptual


Image Letter | Dermatol Pract Concept. 2022;12(3):e2022133 1

Dermatology Practical & Conceptual

Dermoscopy as a Supportive Tool to Differentiate 
Lichen Amyloidosus From Clinical Mimickers 

Emilia N. Cohen Sabban1, Enzo Errichetti2, Horacio A. Cabo1, Esteban Maronna3 

1 Dermatology Department “Instituto de Investigaciones Médicas A. Lanari”, University of Buenos Aires, Argentina

2 Institute of Dermatology, “Santa Maria della Misericordia” University Hospital, Udine, Italy

3 Histopathology Department, Hospital F.J. Muñiz, Buenos Aires, Argentina

Citation: Sabban ENC, Errichetti E, Cabo HA, Maronna E. Dermoscopy as a supportive tool to differentiate lichen amyloidosus from 
clinical mimickers. Dermatol Pract Concept. 2022;12(3):e2022133. DOI: https://doi.org/10.5826/dpc.1203a133

Accepted: December 2, 2021; Published: July 2022

Copyright: ©2022 Sabban et al. This is an open-access article distributed under the terms of the Creative Commons Attribution-
NonCommercial License (BY-NC-4.0), https://creativecommons.org/licenses/by-nc/4.0/, which permits unrestricted noncommercial use, 
distribution, and reproduction in any medium, provided the original authors and source are credited.

Funding: None.

Competing interests: None.

Authorship: All authors have contributed significantly to this publication

Corresponding author: Emilia N. Cohen Sabban, Dermatology Department “Instituto de Investigaciones Médicas A. Lanari”, University of 
Buenos Aires, Argentina, E-mail: emicohensabban@gmail.com

Case Presentation 

A 52-year-old woman presented with a 5-year history of itchy 

hyperkeratotic brownish papules on the legs (Figure 1A) der-

moscopically typified by central brown globules surrounded 

by a pigmented halo (Figure 1B). Histology showed compact 

ortho-hyperkeratosis, irregular acanthosis, and amorphous 

eosinophilic material in the upper dermis which displayed 

positive Congo red staining and a green fluorescence under 

polarized microscopy (Figure 1C), consistently with a diag-

nosis of lichen amyloidosis.

Teaching point

Dermoscopy may be of aid in recognizing lichen amyloidosis 

by showing a peculiar pigmentary pattern resulting from the 

presence of melanin granules within amyloid deposition in 

dermal papilla (central globule) and basal layer hyperpig-

mentation/dermal pigment incontinence (peripheral pigmen-

tation) [1]. Indeed, such dermoscopic clues are different from 

those visible in similar conditions, ie, pretibial pruritic pap-

ular dermatitis (dotted/globular vessels over a pinkish-white 

background) (Figure 1D), lichen myxedematous (white 

structureless areas) (Figure 1E), and lichen planus (Wickham 

striae) (Figures 1F) [1,2].



2 Image Letter | Dermatol Pract Concept. 2022;12(3):e2022133

References 

1. Errichetti E, Lallas A. Other infiltrative conditions. In: Lallas A, 

Errichetti E, Ioannides D, eds. Dermoscopy in General Dermatol-

ogy. 1st ed. Boca Raton, FL: CRC Press; 2018:2-46.

Figure 1. (A) Clinical examination shows hyperkeratotic brownish papules on the legs (better seen in the inset). (B) Dermoscopically 

characterized by central brown globules surrounded by a pigmented halo (magnification in the inset). (C) Histology (H&E; 100x)  

reveals compact orthohyperkeratosis, irregular acanthosis, and amorphous eosinophilic material in the upper dermis which is typified by 

a green fluorescence under polarized microscopy (inset). (D-F) Dermoscopic features of the main clinical mimickers of lichen amyloidosus, 

namely, pretibial pruritic papular dermatitis (dotted vessels over a pinkish-white background – magnification in the upper right inset) (D),  

lichen myxedematous (white structureless areas) (E), and lichen planus (Wickham striae) (F).

2. Errichetti E, Stinco G. Dermoscopy for improving the  

diagnosis of pretibial pruritic papular dermatitis. Australas J  

Dermatol. 2018;59(1):e74-e75. DOI: 10.1111/ajd.12610. 

PMID: 28636138.