{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,7]],"date-time":"2026-07-07T05:15:44Z","timestamp":1783401344753,"version":"3.54.6"},"reference-count":15,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,7,7]],"date-time":"2026-07-07T00:00:00Z","timestamp":1783382400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:p>Hypertrophic lichen planus (HLP) is a chronic, T-cell-mediated inflammatory dermatosis characterized by verrucous, hyperkeratotic papules and predominantly affecting the lower extremities. Dermoscopy has emerged as a valuable non-invasive tool for diagnosing HLP; however, sequential dermoscopic documentation spanning multiple evolutionary stages within a single patient has rarely been reported. Here, we describe a 62-year-old male who presented with progressively enlarging hyperkeratotic nodules on the right lower leg, notably concentrated on the side affected by varicose veins. Dermoscopic examination of lesions at different anatomical sites simultaneously revealed distinct sequential features corresponding to discrete stages of HLP evolution: (1) structureless pigmented areas with hairpin and dotted vessels; (2) diffuse pigmentation with emerging Wickham striae and keratinous plugs (corn pearls); (3) volcano crater-like morphology with elevated keratinous plugs and violaceous striae; and (4) fully developed \u201cbouquet of white roses\u201d pattern with lobulated hyperkeratotic masses. Skin biopsy confirmed the diagnosis with irregular epidermal hyperplasia, wedge-shaped hypergranulosis, and a dense band-like lymphocytic infiltrate. This case demonstrates the full dermoscopic spectrum of HLP across lesions at different stages in a single patient at one time point, and highlights the probable role of chronic venous insufficiency in promoting Koebner-like lesion development. Our findings may assist clinicians in the non-invasive diagnosis and staging of HLP.<\/jats:p>","DOI":"10.3389\/fmed.2026.1881656","type":"journal-article","created":{"date-parts":[[2026,7,7]],"date-time":"2026-07-07T04:22:22Z","timestamp":1783398142000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Case Report: Sequential multi-stage dermoscopic evolution of hypertrophic lichen planus in a patient with varicose veins"],"prefix":"10.3389","volume":"13","author":[{"given":"Xin","family":"Zhang","sequence":"first","affiliation":[{"name":"Department of Dermatology, Hangzhou Third People's Hospital","place":["Zhejiang, Hangzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Junzhu","family":"Xu","sequence":"additional","affiliation":[{"name":"Department of Dermatology, Hangzhou Third People's Hospital","place":["Zhejiang, Hangzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhe","family":"Gao","sequence":"additional","affiliation":[{"name":"Department of Dermatology, Hangzhou Third People's Hospital","place":["Zhejiang, Hangzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,7,7]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"735","DOI":"10.1007\/s40257-024-00878-9","article-title":"Lichen planus: what is new in diagnosis and treatment?","volume":"25","author":"Tekin","year":"2024","journal-title":"Am J Clin Dermatol"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"659","DOI":"10.5858\/arpa.2022-0515-ra","article-title":"Hypertrophic lichen planus: an up-to-date review and differential diagnosis","volume":"148","author":"Whittington","year":"2024","journal-title":"Arch Pathol Lab 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study","volume":"5","author":"Gungor","year":"2015","journal-title":"Dermatol Pract Concept"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"e105043","DOI":"10.7759\/cureus.105043","article-title":"Long-standing unilateral verrucous papules of the hand revealing hypertrophic lichen planus: a diagnostic challenge","volume":"18","author":"Tamim","year":"2026","journal-title":"Cureus"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"8","DOI":"10.3390\/dermatopathology12010008","article-title":"Hypertrophic lichen planus and hypertrophic skin lesions associated with histological lichenoid infiltrate: a case report and literature review","volume":"12","author":"Scotti","year":"2025","journal-title":"Dermatopathol (Basel)"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"89","DOI":"10.1159\/000550461","article-title":"Multiple hypertrophic lichen planus mimicking squamous cell carcinoma: a case report","volume":"18","author":"Hirata","year":"2026","journal-title":"Case Rep Dermatol"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"416","DOI":"10.1684\/ejd.2010.0942","article-title":"Condyloma accuminata-like hypertrophic lichen planus","volume":"20","author":"Zindanci","year":"2010","journal-title":"Eur J Dermatol"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"737813","DOI":"10.3389\/fmed.2021.737813","article-title":"Lichen planus","volume":"8","author":"Boch","year":"2021","journal-title":"Front Med (Lausanne)"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"275","DOI":"10.1007\/s40257-022-00753-5","article-title":"Stasis dermatitis: an overview of its clinical presentation, pathogenesis, and management","volume":"24","author":"Yosipovitch","year":"2023","journal-title":"Am J Clin Dermatol"}],"container-title":["Frontiers in Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2026.1881656\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,7]],"date-time":"2026-07-07T04:22:25Z","timestamp":1783398145000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2026.1881656\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,7]]},"references-count":15,"alternative-id":["10.3389\/fmed.2026.1881656"],"URL":"https:\/\/doi.org\/10.3389\/fmed.2026.1881656","relation":{},"ISSN":["2296-858X"],"issn-type":[{"value":"2296-858X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,7]]},"article-number":"1881656"}}