Dermoscopy of Lichen Scrofulosorum

A 7‐year‐old boy, an untreated case of tuberculous lymphadenitis was referred to us with multiple, asymptomatic, grouped skin colored follicular and perifollicular pinhead‐sized papules over the trunk, arms and back since the past 3 months [Figure 1a]. Another 10‐year‐old girl presented with asymptomatic erythematous to skin colored shiny papules on trunk for the past 5 months similar in morphology as the first case, with an unknown primary focus of tuberculosis for which the child was thoroughly evaluated [Figure 1b]. Dermoscopy of both the cases showed pale round monomorphic grouped perifollicular dots with a central brown follicular plug and marginal rim of fine white scaling [Figure 2]. The second case showed more extensive scaling and marginal hyperpigmentation [Figure 2b]. Histopathology of both the cases showed ill defined, non‐necrotizing epitheloid cell perivascular granulomas [Figure 3]. Ziehl Neelsen stains was negative for acid fast bacilli. In view of the classic morphology and histopathology, both the children were diagnosed as lichen scrofulosorum and both the patients were started on anti‐tubercular therapy.