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Concept: Discoid lupus erythematosus

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Over the last few years, dermoscopy has been shown to be a useful tool in assisting the noninvasive diagnosis of various general dermatological disorders. In this article, we sought to provide an up-to-date practical overview on the use of dermoscopy in general dermatology by analysing the dermoscopic differential diagnosis of relatively common dermatological disorders grouped according to their clinical presentation, i.e. dermatoses presenting with erythematous-desquamative patches/plaques (plaque psoriasis, eczematous dermatitis, pityriasis rosea, mycosis fungoides and subacute cutaneous lupus erythematosus), papulosquamous/papulokeratotic dermatoses (lichen planus, pityriasis rosea, papulosquamous sarcoidosis, guttate psoriasis, pityriasis lichenoides chronica, classical pityriasis rubra pilaris, porokeratosis, lymphomatoid papulosis, papulosquamous chronic GVHD, parakeratosis variegata, Grover disease, Darier disease and BRAF-inhibitor-induced acantholytic dyskeratosis), facial inflammatory skin diseases (rosacea, seborrheic dermatitis, discoid lupus erythematosus, sarcoidosis, cutaneous leishmaniasis, lupus vulgaris, granuloma faciale and demodicidosis), acquired keratodermas (chronic hand eczema, palmar psoriasis, keratoderma due to mycosis fungoides, keratoderma resulting from pityriasis rubra pilaris, tinea manuum, palmar lichen planus and aquagenic palmar keratoderma), sclero-atrophic dermatoses (necrobiosis lipoidica, morphea and cutaneous lichen sclerosus), hypopigmented macular diseases (extragenital guttate lichen sclerosus, achromic pityriasis versicolor, guttate vitiligo, idiopathic guttate hypomelanosis, progressive macular hypomelanosis and postinflammatory hypopigmentations), hyperpigmented maculopapular diseases (pityriasis versicolor, lichen planus pigmentosus, Gougerot-Carteaud syndrome, Dowling-Degos disease, erythema ab igne, macular amyloidosis, lichen amyloidosus, friction melanosis, terra firma-forme dermatosis, urticaria pigmentosa and telangiectasia macularis eruptiva perstans), itchy papulonodular dermatoses (hypertrophic lichen planus, prurigo nodularis, nodular scabies and acquired perforating dermatosis), erythrodermas (due to psoriasis, atopic dermatitis, mycosis fungoides, pityriasis rubra pilaris and scabies), noninfectious balanitis (Zoon’s plasma cell balanitis, psoriatic balanitis, seborrheic dermatitis and non-specific balanitis) and erythroplasia of Queyrat, inflammatory cicatricial alopecias (scalp discoid lupus erythematosus, lichen planopilaris, frontal fibrosing alopecia and folliculitis decalvans), nonscarring alopecias (alopecia areata, trichotillomania, androgenetic alopecia and telogen effluvium) and scaling disorders of the scalp (tinea capitis, scalp psoriasis, seborrheic dermatitis and pityriasis amiantacea).

Concepts: Systemic lupus erythematosus, Lupus erythematosus, Autoimmune diseases, Immunosuppressive drug, Eczema, Psoriasis, Conditions of the skin appendages, Discoid lupus erythematosus

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Summary Background  Dermoscopy is useful in evaluating skin tumours, but its applicability also extends into the field of inflammatory skin disorders. Discoid lupus erythematosus (DLE) represents the most common subtype of cutaneous lupus erythematosus. While dermoscopy and videodermoscopy have been shown to aid the differentiation of scalp DLE from other causes of scarring alopecia, limited data exist concerning dermoscopic criteria of DLE in other locations, such as the face, trunk and extremities. Objective  To describe the dermoscopic criteria observed in a series of patients with DLE located on areas other than the scalp, and to correlate them to the underlying histopathological alterations. Methods  DLE lesions located on the face, trunk and extremities were dermoscopically and histopathologically examined. Selection of the dermoscopic variables included in the evaluation process was based on data in the available literature on DLE of the scalp and on our preliminary observations. Analysis of data was done with SPSS analysis software. Results  Fifty-five lesions from 37 patients with DLE were included in the study. Perifollicular whitish halo, follicular keratotic plugs and telangiectasias were the most common dermoscopic criteria. Statistical analysis revealed excellent correlation between dermoscopic and histopathological findings. Notably, a time-related alteration of dermoscopic features was observed. Conclusions  The present study provides new insights into the dermoscopic variability of DLE located on the face, trunk and extremities.

Concepts: Systemic lupus erythematosus, Lupus erythematosus, Discoid lupus erythematosus

0

Discoidlupus erythematosus (DLE) is a chronic type of cutaneous lupus erythematosus which can present in various morphologies, and the diagnosis can be rather confounding. Prompt evaluation and treatment is necessary to prevent disfigurement and systemic involvement associated with DLE. The following case presented a diagnostic dilemma as the lesion mimicked lupus vulgaris.

Concepts: Systemic lupus erythematosus, Lupus erythematosus, Discoid lupus erythematosus

0

Discoid lupus erythematosus (DLE) is unique from other cutaneous lupus erythematosus (CLE) subtypes because of dyspigmentation and scarring, which are associated with quality of life (QoL) impairment in other skin disorders.(1, 2) While previous QoL studies have included heterogeneous cohorts of patients with CLE, we focused on patients with DLE to identify clinical and demographic features that correlate with QoL impairment. We hypothesized that greater skin disease activity, skin disease damage, dark skin type, female gender, low socioeconomic status (defined by annual income), and current smoking status would be associated with poorer QoL in patients with DLE. This article is protected by copyright. All rights reserved.

Concepts: Systemic lupus erythematosus, Lupus erythematosus, Discoid lupus erythematosus

0

Generalized discoid lupus erythematosus (GDLE) is a newly recognized canine variant of chronic cutaneous lupus erythematosus (CLE) that is not well characterized.

Concepts: Osteoporosis, Systemic lupus erythematosus, Lupus erythematosus, Discoid lupus erythematosus

0

Discoid Lupus (DLE) are characterised by scarring nature lesions that develop perpetuate fibrotic lesions that are not observed in subacute cutaneous lupus erythematosus (SCLE). The pathophysiological basis of this is currently unknown.

Concepts: Systemic lupus erythematosus, Lupus erythematosus, Connective tissue diseases, Discoid lupus erythematosus

0

Cutaneous lupus erythematosus (LE) is an autoimmune disease. The most common clinical forms are acute cutaneous LE (ACLE), subacute cutaneous LE (SCLE) and discoid LE (DLE). Cutaneous LE, mainly ACLE, can be the first sign of systemic LE (SLE). DLE and SCLE are less associated with development of SLE, however, up to 85% of patients with SLE have cutaneous manifestations. The aetiology is multifactorial. Drugs such as proton pump inhibitors can induce SCLE, while UV-light and smoking can worsen the lesions. Treatment includes preventive strategies in addition to topical steroids and systemic hydroxychloroquine.

Concepts: Immune system, Rheumatoid arthritis, Chronic, Corticosteroid, Systemic lupus erythematosus, Lupus erythematosus, Autoimmunity, Discoid lupus erythematosus

0

This study’s objective was to assess the effects of PD-0360324, a fully human immunoglobulin G2 monoclonal antibody against macrophage colony-stimulating factor, in cutaneous lupus erythematosus (CLE). Patients with active subacute CLE or discoid lupus erythematosus were randomized to receive 100 mg or 150 mg PD-0360324 or placebo via intravenous infusion every 2 weeks for 3 months. Blood and urine samples were obtained pre- and post-treatment to analyze pharmacokinetics and pharmacodynamic changes in CD14+ CD16+ monocytes, urinary N-terminal telopeptide (uNTX), alanine/aspartate aminotransferases (ALT/AST) and creatine kinase (CK); tissue biopsy samples were taken to evaluate macrophage populations and T cells using immunohistochemistry. Clinical efficacy assessments included the Cutaneous Lupus Erythematosus Disease Area and Severity Index (CLASI). Among 28 randomized/analyzed patients, peak/trough plasma concentrations increased in a greater-than-dose-proportional manner with dose increases from 100 mg to 150 mg. Statistically significant differences were observed between active treatment and placebo groups in changes from baseline in CD14+ CD16+ cells, uNTX, ALT, AST and CK levels at most time points. The numbers, density and activation states of tissue macrophages and T cells did not change from baseline to treatment end. No between-group differences were seen in CLASI. Patients receiving PD-0360324 reported significantly more adverse events than those receiving placebo, but no serious adverse events. In patients with CLE, 100 mg and 150 mg PD-0360324 every 2 weeks for 3 months suppressed a subset of circulating monocytes and altered activity of some tissue macrophages without affecting cell populations in CLE skin lesions or improving clinical endpoints. This article is protected by copyright. All rights reserved.

Concepts: Immune system, Cell nucleus, Macrophage, Rheumatoid arthritis, Systemic lupus erythematosus, Lupus erythematosus, Immunosuppressive drug, Discoid lupus erythematosus

0

Lupus erythematosus profundus (LEP), which is a variant of chronic cutaneous lupus erythematosus (CLE), is seen in approximately 2∼3% of CLE patients, and only 10% to 20% of LEP patients present with systemic LE (SLE). LEP shows subcutaneous nodules with or without discoid LE (DLE). Linear LEP, a very rare variant of LEP, was first reported in 1991 in Japanese and in 1998 in English. Since LEP sometimes leaves skin depressions or scars as a result of atrophy of adipose tissue, early and adequate treatments are necessary. Here, we introduce an LEP case in which magnetic resonance imaging (MRI) was quite effective in evaluating a lesion that had been considered to be linear DLE.

Concepts: Nuclear magnetic resonance, Magnetic resonance imaging, Skin, Systemic lupus erythematosus, Lupus erythematosus, Connective tissue diseases, Drug-induced lupus erythematosus, Discoid lupus erythematosus

0

Hypertrophic discoid lupus erythematosus, a rare variant of lupus skin disease, can be difficult to distinguish from squamous neoplasms and certain dermatoses microscopically. Recognition, recently, of the pathogenetic significance of plasmacytoid dendritic cells in cutaneous lupus erythematosus, and of their patterns of distribution in different manifestations of the disease, prompted us to study their diagnostic value in the context of hypertrophic discoid lupus erythematosus.

Concepts: Systemic lupus erythematosus, Lupus erythematosus, Discoid lupus erythematosus