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Immunoreactants detected by direct immunofluorescence (DIF) in the skin of patients with lupus erythematosus represent an important tool in the diagnosis of this disorder. Case report: A 46 year old African American female presented complaining of hair loss and scarring in her scalp. Methods: Biopsies for hematoxylin and eosin (H&E) examination, as well as for direct immunofluorescence (DIF) were performed. Results: The histologic features were representative of early lupus erythematosus. DIF demonstrated immune deposits of several immunoglobulins and complement, primarily around skin appendageal structures(hair follicles and sweat glands). Deposits of immunoglobulin D were seen in several areas of the epidermis. Conclusion: In lupus erythematosus, evaluation of immune reactions against cutaneous appendageal structures may be crucial in differentiating this disorder from other autoimmune and non-autoimmune diseases.

Specific cutaneous histologic and immunologic features in a case of early lupus erythematosus scarring alopecia