Dermoscopic Features of Non-Infectious Balanoposthitis

Background/Objectives: Balanoposthitis encompasses a variety of non-infectious conditions that, in some cases, are risk factors for penile cancer. Clinical signs of non-infectious balanoposthitis are often unspecific, whereas dermoscopic features of dermatoses in the genital area can be altered. Current knowledge of the dermoscopy of balanoposthitis is incomplete. This study aimed to evaluate the dermoscopic features of non-infectious balanoposthitis and correlate these features with distinct balanoposthitis types. Methods: Patients with histopathologically confirmed non-infectious balanoposthitis (N = 78) were enrolled in a prospective study, including lichen planus, psoriatic, lichen sclerosus and Zoon's balanoposthitis. Dermoscopic features were compared between each type of non-infectious balanoposthitis using non-parametric statistics. Results: White and purple reticular lines and purple focal structureless areas were dermoscopic variations in Wickham striae were associated with lichen planus, as well as curved linear vessels at the periphery of Wickham striae. Dotted and linear curved vessels in an unspecific arrangement were associated with lichen sclerosus. Other structures included white lines in an unspecific arrangement, white dots and globules and structureless areas. Red and purple globules in lichen sclerosus represented purpura. Notable dermoscopic features that were associated with psoriatic balanoposthitis were yellow-white globules that represented pustules, as well as dotted vessels in a uniform arrangement and patchy white scales. Conclusions: Distinct types of non-infectious balanposthitis are associated with certain dermatoscopic features. Wickham striae have a variable dermoscopic presentation. Some dermoscopic structures can mimic Wickham striae, but vascular patterns can help in differentiating these cases. Pustules can be observed dermoscopically in some psoriasis cases.