Dermatology: Practical and Conceptual Research Letter | Dermatol Pract Concept. 2025;15(2):5078 1 Diagnostic Dermoscopy in Pityriasis Lichenoides Chronica and Pityriasis Lichenoides et Varioliformis Acuta: A Case Series Erika Alba-Rojas1, Andrea Sarahi Guerra-Garza1, Jorge Ocampo-Candiani1 1 Dermatology Department, Hospital Universitario “Dr. José Eleuterio González”, Monterrey, Mexico Citation: Alba-Rojas E, Guerra-Garza AS, Ocampo-Candiani. Diagnostic Dermoscopy in Pityriasis Lichenoides Chronica and Pityriasis Lichenoides et Varioliformis Acuta: A Case Series Dermatol Pract Concept. 2025;15(2):5078. DOI: https://doi.org/10.5826/dpc.1502a5078 Key words: Dermoscopy, Pityriasis Lichenoides Chronica, Pityriasis Lichenoides Et Varioliformis Acuta, Skin Diseases, Differential Diagnosis Accepted: January 7, 2025; Published: April 2025 Copyright: ©2025 Alba-Rojas 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: Erika Alba-Rojas, Dermatology Department, Hospital Universitario “Dr. José Eleuterio González”, Av. Dr. José Eleuterio González 235, Mitras Centro, 64460 Monterrey, Mexico. Email: eri9ar@yahoo.com Introduction Pityriasis lichenoides chronica (PLC) and pityriasis lichenoi- des et varioliformis acuta (PLEVA) are subtypes of pityriasis lichenoides. They require histopathological confirmation. However, noninvasive tools such as dermoscopy can aid in the diagnosis. PLEVA and PLC dermoscopic descriptions are limited to a few case series and reports. We aimed to further describe PLC and PLEVA dermoscopic features for an early diagnosis. Case Presentation We present a retrospective study of 14 patients: six with PLC and eight with PLEVA. All patients had histopatho- logic confirmation and were treated in the dermatology department of a tertiary hospital. The dermoscopy descrip- tion highlighted key characteristics of the lesion, including notable features of the blood vessels. Dermoscopic features are summarized in Table 1. For PLC patients, the mean age at diagnosis was 20 years (±12.7), with a female-to-male 2 Research Letter | Dermatol Pract Concept. 2025;15(2):5078 ratio of 2:1. The median disease evolution was eight months (±11.1). The most frequent dermoscopic features were light brown areas and superficial scales (83.3% for both fea- tures). The predominant vascular pattern was dotted vessels (66.7%) (Figure 1). For PLEVA patients, the mean age at di- agnosis was 30 years (±14.8), with a female-to-male ratio of 7:1. The median disease evolution was 17 months (±15.3). The most common dermoscopic feature was a targetoid pattern (75%); three (37.5%) of these patients had criteria for an early-phase lesion and only one for a late-phase le- sion (12.5%). Also, amorphous areas with brownish scaling (62.5%) and dotted vessels were common features (62.5%) (Figure 2). Light brown areas and superficial scales are the dermoscopic features described in PLC patients from India [1,2]; the pigmented lesions correspond to post- inflammatory hyperpigmentation [2], a finding frequently seen in our patients, in contrast with yellowish-orange structureless, which is the most frequently reported find- ing in the literature in patients with light skin tones [1-3]. Erricheti et al. [3] described the presence of dotted vessels, as seen in our patients, which represent dilated superficial capillaries without constant papillomatosis [1]. PLEVA is described as an early-phase lesion containing crusted brown and amorphous areas or a late-phase lesion with a central white patch, both with a targetoid or pinpoint ring aspect [4] characterized by three zones: central clod, intermediate ring white scale, and peripheral vascular ring [5]. Ankad et al. [4] correlate it to blood vessel dilation and microhe- morrhages in the papillary dermis. In our patients, early- phase lesions were predominantly seen, remarkably in patients with a targetoid aspect, followed by amorphous areas with brownish scaling. Table 1. Dermatoscopic Features of Patients with PLC and PLEVA. PLC Dermoscopic Findings (N=6) N (%) Superficial scales 5 (83.3%) Light brown areas 5 (83.3%) Orange-yellow zones 2 (33.3%) Hypopigmentation 1 (16.7%) Brown central rim 0 (0%) Multiple scattered brown granules 0 (0%) Blood vessels Dotted 4 (66.7%) Linear 1 (16.7%) Branched 1 (16.7%) Milky red areas 1 (16.7%) Irregular 0 (0%) PLEVA Dermoscopic Findings (N=8) Halo surrounding central lesion (pinpoint ring) 6 (75%) Amorphous areas with brownish desquamation 5 (62.5%) Brown dots on erythematous background 4 (50%) Central brown crusty lesion 3 (37.5%) Papule with white central patch 1 (12.5%) Blue-gray focal areas 0 (0%) Blood vessels Dotted 5 (62.5%) Linear 3 (37.5%) Glomerular 1 (12.5%) Abbreviations: PLC = pityriasis lichenoides chronica; PLEVA = pityriasis lichenoides et varioliformis acuta. Research Letter | Dermatol Pract Concept. 2025;15(2):5078 3 Figure 1. Dermoscopy of pityriasis lichenoides chronica. (A, B) Pinpoint pattern (blue arrows). (C) Pinpoint pattern (green arrow) and dotted vessels on an erythematous background (green arrow). (D) Dotted vessels on an erythematous background (purple arrow). Conclusion We highlight the use of dermoscopy as a noninvasive tool to recognize patterns and help diagnose PLC and PLEVA for timely and effective management. We propose that le- sions with light brown areas and superficial scales are sug- gestive of PLC, while targetoid patterns are more indicative of PLEVA. 4 Research Letter | Dermatol Pract Concept. 2025;15(2):5078 by dermoscopy. Clin Exp Dermatol. 2015 Oct 1;40(7):804–6. DOI: 10.1111/ced.12580. PMID: 25682853 4. Ankad BS, Beergouder SL. Pityriasis lichenoides et varioliformis acuta in skin of color: new observations by dermoscopy. Der- matol Pract Concept. 2017 Feb 2; DOI: 10.5826/dpc.0701a05. PMID: 28243491 5. Arias-Rodriguez C, Hoyos-Gaviria JG, Muñoz-Monsalve AM, Hernandez-Martinez A. Dermoscopy of pityriasis lichenoides et varioliformis acuta (PLEVA). An Bras Dermatol. 2023 Jan 1; DOI: 10.1016/j.abd.2022.04.017. PMID: 37661463 References 1. Jindal R, Chauhan P, Sethi S. Dermoscopic characterization of gut- tate psoriasis, pityriasis rosea, and pityriasis lichenoides chronica in dark skin phototypes: An observational study. Dermatol Ther. 2021 Jan 1;34(1). DOI:10.1111/dth.14631. PMID: 33277950 2. Sonthalia S, Varma S, Khopkar U. Dermoscopy of Pityriasis Lichenoides Chronica in an Indian Girl. Indian Dermatology Online Journal. 2020;11;477–8. DOI: 10.4103/idoj.IDOJ_455_18. PMID: 32695726 3. Errichetti E, Lacarrubba F, Micali G, Piccirillo A, Stinco G. Differ- entiation of pityriasis lichenoides chronica from guttate psoriasis Figure 2. Dermoscopy of pityriasis lichenoides et varioliformis acuta. (A, B) Pinpoint pattern (blue arrows). (C) Pinpoint pattern (blue arrow) and dotted vessels in erythematous background (blue arrow). (D) Dotted vessels on an erythematous background (green arrow).