Unmasking Facial Melanosis: A Prospective Clinico-Dermoscopic Study.
- 1Department of Dermatology Venereology and Leprosy, Christian Medical College, Vellore, India.
- 2Department of Pathology, Christian Medical College, Vellore, India.
Abstract
Introduction
Various entities of acquired facial melanosis present with considerable clinical overlap, posing diagnostic challenges. Dermoscopy is being increasingly used in its diagnosis.Objectives
To assess dermoscopic and clinicopathological features of facial melanosis in Fitzpatrick skin types IV-VI.Methods
A prospective cross-sectional study of clinical and dermoscopic features of facial melanosis-lichen planus pigmentosus (LPP), pigmented contact dermatitis (PCD), and facial acanthosis nigricans (FAN)-was conducted. Melasma, periorbital hyperpigmentation, and nevus of Ota were excluded.Results
Fifty-six patients were included: 31 (55.4%) with LPP, 18 (32.1%) FAN, and seven (12.5%) PCD. Clinically, LPP showed significantly more involvement of face (55.2 ± 22.2%) (P=0.029), especially the chin (29, 93.5%) (P=0.006). Dermoscopy revealed more than one pattern of pigment structures in 54 (96.4%) patients. Predominant patterns in LPP were reticular (21, 67.7%), peppered (15, 48.4%), and annular (13, 41.9%). There was an overlap of patterns like annular, annular-granular, and reticular in both LPP and PCD. Peppered (15, 48.4%) was significantly more in LPP (P=0.023), while linear dots were seen exclusively in LPP (4, 12.9%); smudged was significantly more in PCD (6, 85.7%) and FAN (15, 83.3%) (P=0.003). Concentric circles (16, 88.9%) and parallel lines (14, 77.8%) were significantly more in FAN (P<0.001 each), while crypts-gyri (10, 55.6%) and papillary projections (8, 44.4%) were seen exclusively in FAN. Combination of dots and clods was also significantly more in LPP (26, 83.9%; P=0.007), whereas blue-gray pigmentation (19, 61.3%) was observed exclusively in LPP.Conclusion
Distinct dermoscopic features aid in differentiating acquired facial melanosis. Blue-gray dots and clods in peppered, reticular, and linear dots patterns favor LPP, while concentric circles, parallel lines, crypts-gyri, and papillary projections suggest FAN. Recognition of these patterns may obviate biopsy in cosmetically sensitive areas.
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BibTeX
@article{jose2026unmasking,
title = {{Unmasking Facial Melanosis: A Prospective Clinico-Dermoscopic Study.}},
author = {Sheethal K Jose and Priya Sara Kuryan and Diya Katrina Koikkara and Gauri Dinesh Mahabal and Leni George and C V Dincy Peter and Susanne A Pulimood and Meera Thomas},
journal = {Dermatology practical \& conceptual},
year = {2026},
month = jul,
doi = {10.5826/dpc.1603a7032},
url = {https://europepmc.org/article/MED/42858383},
note = {CC BY-NC},
}
RIS
TY - JOUR
TI - Unmasking Facial Melanosis: A Prospective Clinico-Dermoscopic Study.
AU - Sheethal K Jose
AU - Priya Sara Kuryan
AU - Diya Katrina Koikkara
AU - Gauri Dinesh Mahabal
AU - Leni George
AU - C V Dincy Peter
AU - Susanne A Pulimood
AU - Meera Thomas
PY - 2026
DA - 2026/07/31
JO - Dermatology practical & conceptual
DO - 10.5826/dpc.1603a7032
UR - https://europepmc.org/article/MED/42858383
AB - Introduction Various entities of acquired facial melanosis present with considerable clinical overlap, posing diagnostic challenges. Dermoscopy is being increasingly used in its diagnosis.Objectives To assess dermoscopic and clinicopathological features of facial melanosis in Fitzpatrick skin types IV-VI.Methods A prospective cross-sectional study of clinical and dermoscopic features of facial melanosis-lichen planus pigmentosus (LPP), pigmented contact dermatitis (PCD), and facial acanthosis nigricans (FAN)-was conducted. Melasma, periorbital hyperpigmentation, and nevus of Ota were excluded.Results Fifty-six patients were included: 31 (55.4%) with LPP, 18 (32.1%) FAN, and seven (12.5%) PCD. Clinically, LPP showed significantly more involvement of face (55.2 ± 22.2%) (P=0.029), especially the chin (29, 93.5%) (P=0.006). Dermoscopy revealed more than one pattern of pigment structures in 54 (96.4%) patients. Predominant patterns in LPP were reticular (21, 67.7%), peppered (15, 48.4%), and annular (13, 41.9%). There was an overlap of patterns like annular, annular-granular, and reticular in both LPP and PCD. Peppered (15, 48.4%) was significantly more in LPP (P=0.023), while linear dots were seen exclusively in LPP (4, 12.9%); smudged was significantly more in PCD (6, 85.7%) and FAN (15, 83.3%) (P=0.003). Concentric circles (16, 88.9%) and parallel lines (14, 77.8%) were significantly more in FAN (P<0.001 each), while crypts-gyri (10, 55.6%) and papillary projections (8, 44.4%) were seen exclusively in FAN. Combination of dots and clods was also significantly more in LPP (26, 83.9%; P=0.007), whereas blue-gray pigmentation (19, 61.3%) was observed exclusively in LPP.Conclusion Distinct dermoscopic features aid in differentiating acquired facial melanosis. Blue-gray dots and clods in peppered, reticular, and linear dots patterns favor LPP, while concentric circles, parallel lines, crypts-gyri, and papillary projections suggest FAN. Recognition of these patterns may obviate biopsy in cosmetically sensitive areas.
SN - 2160-9381
ER -