Common inflammatory skin diseases can be correctly diagnosed with clinical examination. However, unusual presentations do exist and may cause difficulties in the differentiation among different entities, and histopathology is required for an accurate diagnosis. In this regard, dermoscopy and reflectance confocal microscopy (RCM) can play an important role in increasing the specificity of the diagnosis, offering the possibility of improved management of patients. In this review, the authors have analyzed dermoscopic patterns of lichen planus, discoid lupus erythematosus, psoriasis and alopecias as prototypes of inflammatory skin diseases, and correlated them with RCM microscopical features. RCM, thanks to its correspondence to histology and to the possibility of an immediate correlation to dermoscopy, provides additional information useful for increasing the sensibility and specificity of dermoscopy.