Diagnosis: Discoid Lupus Erythematosus (DLE)
Diagnosis: Discoid Lupus Erythematosus (DLE) Findings: Erythema, hyperpigmentation, hypopigmentation, scarring and scaling can be seen together Most commonly affects the upper body, especially in sun-exposed areas Can lead to hair loss such as in the scalp Key teaching points: Can be triggered by exposure to sunlight Smoking can exacerbate this condition Treatment includes strict sun [ ]
Diagnosis: Discoid Lupus Erythematosus (DLE) Findings: - Erythema, hyperpigmentation, hypopigmentation, scarring and scaling can be seen together - Most commonly affects the upper body, especially in sun-exposed areas - Can lead to hair loss such as in the scalp Key teaching points: - Can be triggered by exposure to sunlight - Smoking can exacerbate this condition - Treatment includes strict sun protection, and may include topical treatments such as corticosteroids, and systemic immunosuppressants and immunomodulators Credit: Case submitted by dermatologist Dr. Azeem Alam Khan to dermRounds Dermatology Network
Well-defined erythematous, scaly plaques with follicular plugging, most commonly on sun-exposed areas (face, scalp, ears). Scarring, dyspigmentation, and permanent alopecia in chronic lesions.
Sun protection (critical). First-line: potent topical corticosteroids, intralesional triamcinolone, calcineurin inhibitors. Systemic: hydroxychloroquine 200-400 mg/day. Refractory: methotrexate, mycophenolate, thalidomide, lenalidomide.
• Subacute cutaneous lupus erythematosus • Psoriasis • Lichen planus • Tinea faciei • Granuloma annulare • Sarcoidosis • Morphea • Actinic keratosis
• Most common form of chronic cutaneous lupus — only ~5-10% progress to SLE • Classic triad: erythema, scale with follicular plugging, and atrophic scarring • Carpet tack sign: adherent scale with follicular plugging seen on underside of removed scale • Scarring alopecia is a significant complication — early treatment prevents permanent hair loss • DIF (lupus band test): granular deposits of IgG, IgM, IgA, and C3 at DEJ in lesional skin • Dyspigmentation (central hypopigmentation with peripheral hyperpigmentation) especially prominent in darker skin • More common in African Americans and women
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