Diagnosis: Discoid Lupus Erythematosus
A 34-year-old female presenting with erythematous, scaly plaques on the scalp and face with central scarring, dyspigmentation, and patchy hair loss.
Erythema, hyperpigmentation, and central hypopigmentation with adherent scale and follicular plugging on the scalp, conchal bowls, and malar cheeks. Scarring alopecia with loss of follicular ostia in affected scalp areas. Active borders show erythema and scale; central areas show atrophy and depigmentation.
Onset 8 months ago with erythematous patches on the scalp initially treated as seborrheic dermatitis. Progressive hair loss prompted biopsy. ANA weakly positive at 1:80 (speckled pattern); dsDNA negative; complement levels normal.
Strict sun protection with broad-spectrum SPF 50+ sunscreen. Smoking cessation counseling. Topical clobetasol propionate 0.05% solution for scalp, tacrolimus 0.1% ointment for facial lesions. Hydroxychloroquine 200mg twice daily initiated.
• 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
Tags: lupus, autoimmune, scarring alopecia, sun-exposed, hydroxychloroquine