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Skin-nontumor / Clinical Dermatology

Other dermatoses

Lupus erythematosus - Chronic discoid lupus


Reviewer: Mowafak Hamodat, MB.CH.B, MSc., FRCPC, Eastern Health, St. Johns, Canada (see Reviewers page)
Revised: 1 August 2011, last major update August 2011
Copyright: (c) 2002-2011, PathologyOutlines.com, Inc.

Definition
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● Distinct entity from systemic lupus erythematosus (SLE), despite similar names
● No systemic manifestations, although 1/3 with SLE have discoid type lesions
● Common, usually women; may be exacerbated by sunlight
● Lupus profundus: preferential lymphocytic infiltration of subcutaneous fat

Clinical description
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● Localized or generalized pattern
● Only 1% with localized variant develop systemic disease versus 5% with generalized variant
● May become worse during spring/summer
● Sharply circumscribed erythematous, atrophic or hyperkeratotic, shiny and scaling plaques on face, neck, scalp, arms or trunk
● Plaques may have follicular keratotic plugs

Micro description
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● Follicular hyperkeratosis, epidermal atrophy and acanthosis with degeneration of basal layer, periadnexal lymphocytic infiltrate
● May have flask-shaped plugs of stratum corneum filling follicular orifices
● Older lesions have thick and irregular basement membranes
● Usually reticular dermal mucin
● Rare plasma cells

Positive stains
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Lupus band test - IgG, IgM, C5b-C9 (by direct immunofluorescence) in clinically involved skin as irregular band at dermoepidermal junction
● IgG and IgM in 50% in normal skin
● Also positive for mucin stains (Alcian blue, colloidal iron)

Differential diagnosis
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● Verrucous and hyperkeratotic chronic discoid lupus lesions on upper extremities resemble hypertrophic lichen planus or keratoacanthoma
● Also polymorphous light eruption, chronic dermatitis, Jessnerís lymphocytic infiltrate of skin

End of Skin-nontumor / Clinical Dermatology > Other dermatoses > Lupus erythematosus - Chronic discoid lupus


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