Dermoscopic Monitoring of Therapeutic Regression in Actinic Lichen Planus: A Practical Illustration of Inflammoscopy in Clinical Care.

Dermoscopic monitoring has emerged as a valuable noninvasive adjunct for evaluating inflammatory dermatoses by providing objective assessment of disease activity and therapeutic response. Its role in actinic lichen planus (ALP), however, remains incompletely characterized. We report a biopsy-confirmed case of ALP in a middle-aged man presenting with asymptomatic hyperpigmented plaques over photoexposed areas of the face. Baseline polarized dermoscopy demonstrated annular Wickham's striae, a central gray structureless area, gray-brown dots, fine white scales, and diffuse brown pigmentation. Histopathological examination revealed compact orthokeratosis, wedge-shaped hypergranulosis, basal cell vacuolar degeneration, pigment incontinence, and a dense band-like lichenoid lymphocytic infiltrate, confirming the diagnosis. The patient received combined therapy comprising oral hydroxychloroquine, topical corticosteroid therapy, broad-spectrum photoprotection, and two sessions of fractional CO2 laser performed at 4-week intervals. At the 8-week follow-up, clinical improvement was accompanied by attenuation of inflammatory dermoscopic structures with persistence of residual pigmentary features, reflecting regression of active interface dermatitis despite ongoing postinflammatory pigmentation. This case highlights the clinicodermoscopic and histopathological correlation in ALP and illustrates the practical utility of dermoscopic monitoring (inflammoscopy) as a noninvasive adjunct for assessing therapeutic response in routine clinical practice.