Diagnosis: Discoid lupus erythematosus
A punch biopsy and tissue pathology confirmed that our patient had discoid lupus erythematosus (DLE).
DLE is a common type of cutaneous lupus that is chronic and is typically associated with atrophy and scarring of the skin. The primary discoid lesion is a discrete erythematous papule or plaque with adherent scaling, follicular plugging, atrophic scarring, central hypopigmentation, and hyperpigmented borders.
DLE is a dermatosis that is localized in 80% of patients and occurs mainly on sun-exposed areas of the skin, such as the scalp, face, and ears. In 20% of cases it occurs on the extremities and upper trunk. Women are affected more than men, and it can affect any age group, although it is more common in individuals between the ages of 20 and 40.1
The etiology of DLE is unknown. What we do know is that less than 5% of patients with DLE eventually end up with systemic lupus erythematosus (SLE), while up to 25% of patients with SLE go on to develop chronic discoid lesions.2
Abnormalities in serology are not common in DLE. About 20% of patients with DLE show positive antinuclear antibody titers when tested. This is the case in the presence of widespread disease more so than in localized DLE. The presence of antinative (antidouble-stranded) or anti-Smith antibodies is usually suggestive of systemic symptoms and occurs in 5% of cases.3