DERMOSCOPIC FEATURES OF LUPUS CHEILITIS IN DARK-SKINNED PHOTOTYPES: A CROSS-SECTIONAL STUDY OF 13 PATIENTS

Background: Cheilitis encompasses a heterogeneous group of inflammatory lip disorders that are often difficult to diagnose clinically, particularly in the absence of associated cutaneous lesions. Dermoscopy is a useful, non-invasive adjunct that can orient the underlying aetiology through specific criteria. Data on the dermoscopic features of lupus cheilitis remain scarce, especially in dark-skinned populations. 
Objective: To identify the main dermoscopic characteristics of lupus cheilitis in patients with dark phototypes, in order to improve diagnostic orientation and limit unnecessary biopsies.
Methods: We conducted a descriptive and analytical, monocentric, cross-sectional study from January 2023 to April 2024, including patients with clinically and/or histologically confirmed lupus cheilitis. Dermoscopic images were acquired using a DermLite DL4 or DL5 device and independently analysed by two dermatologists.
Results: Thirteen patients were included. The mean age was 52.7 years, with a female predominance (61.5%). All patients had Fitzpatrick phototype IV, and lip involvement was bilateral in 100% of cases. Most patients lived in an urban area (69.2%). Hypertension and smoking were each found in 15.4% of patients, and diabetes in 7.7%. Chronic sun exposure was reported in 7.7% of patients, and lupus disease was clinically active in 84.6%. The main dermoscopic signs were a white-red background (64.3%), white scales with a central distribution (64.3% and 57.2%, respectively), polymorphous vascularization (71.4%) dominated by hairpin vessels (64.3%), and whitish radial lines (50%). Rosettes were present in 35.7% of cases and were the only feature statistically associated with lupus (p = 0.013).
Conclusion: Dermoscopy appears to be a valuable diagnostic aid in lupus cheilitis, particularly when cutaneous signs are absent. A white-red background, white scales, hairpin-predominant polymorphous vascularization and whitish radial lines were the most evocative features in our series, while rosettes constituted the main sign statistically associated with lupus, suggesting their potential value as a dermoscopic clue orienting the diagnosis.