Dermoscopic Characteristics of Lupus Vulgaris in Fitzpatrick Skin Phototypes V and VI: A Multicentre South African and Indian Observational Study

Lupus vulgaris, a common form of cutaneous tuberculosis, poses diagnostic difficulties, especially in individuals with darker skin. Dermoscopy is a useful non-invasive tool, but its features for lupus vulgaris in Fitzpatrick skin phototypes V and VI remain inadequately described. This study aimed to characterise the dermoscopic findings of lupus vulgaris in patients with Fitzpatrick skin phototypes V and VI. A multicentre, observational, cross-sectional study was performed at tertiary dermatology centres in South Africa and India. Consecutive patients with a clinical and histopathological confirmation of lupus vulgaris and Fitzpatrick skin phototypes V or VI were enrolled. Standardised dermoscopic images of lesions were analysed by two independent, blinded dermatologists. The most frequent dermoscopic features were white structureless areas (92% of cases), linear branching vessels (85%), and yellow-orange structureless areas (78%). A distinctive ‘white starburst’ pattern, consisting of radiating white streaks, was observed in 63% of lesions. Ulceration and haemorrhagic crusts were less commonly seen. Lupus vulgaris in darker skin phototypes exhibits consistent dermoscopic patterns, primarily white structureless areas and linear branching vessels. The ‘white starburst’ pattern may represent a characteristic feature. Dermoscopy should be incorporated into the routine evaluation of suspected cutaneous tuberculosis in darker skin. Further prospective research is required to validate these patterns and evaluate their diagnostic specificity against other granulomatous dermatoses. cutaneous tuberculosis, lupus vulgaris, dermoscopy, skin of colour, Fitzpatrick phototype, Africa, India This study provides the first multicentre description of the dermoscopic features of lupus vulgaris in Fitzpatrick skin phototypes V and VI, offering a reference for clinicians in regions where these phototypes are prevalent.