Dermoscopic features of discoid lupus erythematosus

An otherwise healthy 38-year-old man presented with skin lesions over his scalp and face of several months’ duration. The lesions were exacerbated after sun exposure. Physical examination showed many erythematous to brownish alopecia patches located on his scalp (Figure 1A) and atrophic plaques on his face (Figure 1B). Laboratory studies including hematologic tests, erythrocyte sedimentation rate, anti-nuclear antibody, and routine urine tests were within normal limits. Anti-dsDNA was 10 KIU/L (normal limit <10 KIU/L). Dermoscopy (DermLite II ProHR 3Gen; 3Gen, San Juan, Capistrano, CA, USA) of the long-lasting scalp lesion showed branching red lines with white and brown dyschromia. Follicular ostia were reduced in number (Figure 1C). Dermoscopy of the right cheek lesion showed erythematous and brown dyschromia with central white macules and red lines at the periphery of the lesion (Figure 1D). Histopathologic examination of a biopsy specimen from the scalp lesion showed interface dermatitis with superficial and deep perivascular and periappendageal lymphocytic dermatitis. Epidermal atrophy and a thickened basement membrane were noted. The papillary dermis showed dilated vessels (Figure 1E). Thick collagen bundle and dermal fibrosis were noted over white colored area of dermoscopic image (Figure 1G). A biopsy specimen from the right cheek lesion showed atrophic epidermis. A thickened basement membrane and pigment incontinence were prominent. The dermis showed dilated vessels (Figure 1F). Dermal fibrosis and increased fibroblasts were noted over white colored area of dermoscopic image (Figure 1H). Direct immunofluorescence examination of both specimens showed IgG and focal IgA bands at the dermoepidermal junction. Discoid lupus erythematosus (DLE) was diagnosed. The active DLE lesions were treated with mometasone furoate 0.1% cream and followed up by dermoscopy. In a recent-onset active auricular lesion, follicular keratin plugs (arrows) and scales (arrowheads) cleared after treatment with residual red dyschromia and telangiectasia (Figure 2A, B).