Dermoscopy of hypertrophic lupus erythematosus and differentiation from squamous cell carcinoma (original) (raw)
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Archives of Pathology & Laboratory Medicine, 2013
Hypertrophic lupus erythematosus (HLE) is rare variant of chronic cutaneous lupus characterized histologically by irregular epidermal hyperplasia associated with features of classic chronic cutaneous lupus, including interface changes. Lesions frequently demonstrate reactive squamous atypia of the basal layer and may show histopathologic overlap with other more common cutaneous atypical squamoproliferative lesions. Typical histologic features of cutaneous lupus, such as follicular plugging, angiocentric lymphocytic inflammation, and dermal mucin, are very helpful clues to the diagnosis of hypertrophic lupus erythematosus. Recently, immunohistochemistry for CD123 used to detect increased plasmacytoid dendrocytes in hypertrophic lupus erythematosus has proven to be diagnostically useful. A high index of suspicion for hypertrophic lupus erythematosus is essential to avoid overdiagnosis of squamous neoplasia, particularly in limited cutaneous biopsies in the absence of adequate clinical...
Squamous Cell Carcinoma Complicating Discoid Lupus Erythematosus
International Journal of Dermatology, 1987
A 45-year-oid Chinese woman with a 12-year history of discoid lupus erythematosus (DLE) presented to our hospital v^/ith two fungating tumors on her DLE lesions on both forearms. The tumors had started on each forearm as nodules that grew slowly over 6 months. There was no preceding history of trauma or ionizing radiation to the forearms. She was treated with topical steroids by her general practitioner earlier. Examination then showed DLE plaques on her forearms, dorsum of the hands, face, and legs. A fungating tumor (measuring 7 cm in diameter each) was present on DLE plaques on each forearm (Fig. 1}. Abnormal laboratory findings included raised ESR (70 mm/hr) and positive antinuclear antibody test (titer 1/20, homogenous nuclear pattern). Results of blood counts, direct Coomb's test, liver function and renal function tests, VDRL test, urinaiysis, and chest x-ray were normal. Wide excision of the tumors with a skin graft of normallooking skin taken from the covered parts of both thighs was done. Histology of the excised tumor showed well-differentiated squamous cell carcinoma with dense lymphocytic dermal infiltrate (Fig. 2). The skin surrounding the tumor showed characteristic lupus erythematosus changes with epidermal atrophy, vacuoiar basal cell degeneration, thickened basement membrane, periappendageal lymphohistiocytic infiltrates, and telangiectasia in the upper and mid-dermis (Eig. 3). Direct immunofluorescence studies were negative. Eight months after surgery, new DLE lesions developed on the grafted skin (Fig. 4), and a biopsy specimen showed similar changes of DLE. The patient was given oral chloroquine sulfate 450 mg daily, and the DLE lesions became less erythematous; some lesions healed with scarring and no new lesions appeared. Chloroquine was tapered over 2 years, and the patient remained fairly well with residual DLE plaques on her forearms.
Dermoscopy of discoid lupus erythematosus
British Journal of Dermatology, 2013
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 timerelated 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.
Dermoscopy of Lupus Miliaris Disseminatus Faciei: A Step Closer to Diagnosis
Dermatology Practical & Conceptual
Lupus miliaris disseminatus faciei (LMDF) is an uncommon chronic inflammatory and granulomatous dermatosis, the exact etiology of which is hitherto unknown. LMDF typically manifests as yellowish red to brown papules on the face, particularly around the eyelids [1]. We present a case of LMDF and describe the dermoscopic findings of the case with histological correlation. Case Presentation A 32-year-old-man presented to the dermatology department with complaints of multiple raised reddish lesions over the face for the preceding 8 months. There was no history of redness of the face, photosensitivity, or other skin lesions. On mucocutaneous examination, multiple, discrete, reddish brown papules and plaques were seen over both cheeks, forehead, nose, and chin. There was clustering of lesions around the chin and periocular, perinasal, and perioral areas. No surface change, background erythema, or telangiectasia was seen. A few pitted scars were also present on both cheeks (Figure 1, A-C). Dermoscopic examination (DermLite II Hybrid M Dermatoscope, magnification ×10 in polarized mode) revealed multiple, ill-defined, yellow to orangish brown, structureless areas present perifollicularly, few of which were filled with yellow or white keratotic follicular plugs (Figure 2, A and B). Histopathological examination of the patient revealed acanthotic epidermis with follicular plugging. Dermis showed well-defined, predominantly perifollicular, epithelioid cell granulomas, focal caseous necrosis, and Langhans and foreign body giant cells (Figure 3, A-C). Stains done for microorganisms (PAS, ZN) were negative. Routine laboratory investigations including Mantoux test, chest x-ray, and serum angiotensin-converting enzyme levels were all within normal limits. A diagnosis of LMDF was made after clinicopathological correlation and the patient was started on tablet doxycycline 100 mg twice a day for 6 weeks. Although the patient did not follow up in person, upon telephonic inquiry he reported significant improvement and doxycycline was tapered to 100 mg once a day for another 4 weeks.
White rosette in discoid lupus erythematosus: New dermoscopic observation
Dermatology practical & conceptual, 2017
A 60-year-old male presented with depigmented scaly lesions on the scalp and anterior neck, which he had noticed for four months. The lesions were asymptomatic and stationary. A detailed cutaneous examination revealed faint hyperpigmented borders surrounding the depigmented patches. Dermoscopy showed white structureless areas, branching telangiectasia, and blue-gray globules sprinkled in a few places on the white areas and white rosettes in many places (Figure 1).
White rosette in discoid lupus erythematosus: a new dermoscopic observation
Dermatology practical & conceptual, 2017
A 60-year-old male presented with depigmented scaly lesions on the scalp and anterior neck, which he had noticed for four months. The lesions were asymptomatic and stationary. A detailed cutaneous examination revealed faint hyperpigmented borders surrounding the depigmented patches. Dermoscopy showed white structureless areas, branching telangiectasia, and blue-gray globules sprinkled in a few places on the white areas and white rosettes in many places (Figure 1).
Histopathological Review on Discoid Lupus Erythematosus Mimicking Granuloma Faciale: One Case Report
2021
Discoid lupus erythematosus (DLE) is one of the most common forms of cutaneous lupus erythematosus. It is characterized by clinical manifestations of erythematous macules, papules, or plaques with a coin-like shape, and the face is the most common predilection site. Clinical features often resemble other lupus types and granuloma faciale. This case report aimed to distinguish discoid lesions on the face based on the histopathological examination. A 71-year-old male with a few reddish lumps appeared on his face three months ago. Physical examination showed multiple discrete erythematous plaques with overlying squamous. Hematoxylin and eosin staining on the epidermis demonstrated basket weave type orthokeratosis, basal vacuolar cell degeneration, epidermal atrophy with flat rete ridges, and follicular plugging while in the dermis obtained inflammatory cell infiltrates, especially in periadnexal areas. Histopathological features of DLE are hyperkeratosis, pilosebasea gland atrophy, fol...
Hypertrophic lupus erythematosus: case report
Acta dermatovenerologica Croatica : ADC, 2009
Discoid lupus erythematosus is the most common form of cutaneous lupus erythematosus. It is more common in women than in men, in individuals between 20 and 40 years of age. It is an inflammatory autoimmune disease in which genetically predisposed individuals are stimulated by hormonal and a variety of exogenous factors including UV radiation, stress, infections, and even temperature changes. Lesions are characterized by erythema, hyperkeratosis and atrophy. Typical sites are light-exposed areas, i.e. forehead, nose, cheeks, upper part of the back, upper chest, and dorsal aspects of the hands and feet. A case of lupus erythematosus hypertrophicus with very good and rapid treatment results with antimalarials and topical corticosteroid is presented.
Diagnostic Challenges of Hypertrophic Lupus Erythematosus
SKIN The Journal of Cutaneous Medicine
Hypertrophic lupus erythematosus (HLE) often occurs in the absence of systemic symptoms and can be misdiagnosed as squamous cell carcinoma (SCC) as both appear clinically as erythematous scaling plaques in sun exposed areas and histologically show significant epithelial hyperplasia. No single criterion confidently differentiates HLE from SCC histologically, postulating the need for CD123 immunostaining in evaluating locally recurring, supposed SCCs. We present a woman who presented for evaluation of multiple supposed left lower leg well-differentiated SCCs (wdSCC), that did not resolve following Mohs Micrographic Surgery and other techniques aimed at cancer removal. The lesions improved following intralesional Kenalog injection and showed positive CD123 immonostains, which both led to the diagnosis of HLE.