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When lupus scars the face: Extensive discoid lupus erythematosus
Maria Camila Marin Murillo
1,2, Sergio Castillo-Pinto1,2, Juan Nicolas Sarmiento Naranjo2,3, Anna Di Berardinis2,4, Juan Camilo Parra2
1Dermatologist, Pontificia Universidad Javeriana, Bogota, Colombia, School of Medicine, Pontificia Universidad Javeriana, Bogota, Colombia, 2Department of Dermatology, Hospital Universitario de la Samaritana, Bogota, Colombia, 3Medical doctor, Universidad Pontificia Bolivariana, Medellin, Colombia, 4Medical intern, Universidad de la Sabana, Bogota, Colombia
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Sir,
Discoid lupus erythematosus (DLE) is the most common form of chronic cutaneous lupus erythematosus and may lead to permanent scarring and alopecia, with an overall incidence rate of CLE of 3.9% per 100,000, with no sex or age predilection [1,2].
A 28-year-old woman with systemic lupus erythematosus presented with a 6-month history of progressive erythematous-violaceous scaling plaques involving the face, scalp, ears and upper extremities despite treatment with methotrexate, prednisolone and hydroxychloroquine. Examination revealed extensive scarring plaques with loss of follicular ostia and large areas of cicatricial alopecia (Figs 1a and 1b). Dermoscopy showed prominent follicular plugs and whitish scales (Fig. 2). Histopathological examination demonstrated vacuolar interface dermatitis, pigment incontinence, perifollicular lymphocytic infiltrate and follicular plugging, confirming discoid lupus erythematosus (Fig. 3).
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Figure 1a: Frontal view showing extensive erythematous-violaceous, scarring, and scaling plaques involving the face. |
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Figure 1b: Lateral view showing extensive erythematous-violaceous, scarring, and scaling plaques involving the face and ear. |
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Figure 2: Whitish patchy scales and follicular plugging. |
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Figure 3: (H&E) stain. Focal vacuolar interface damage in the epidermis, with pigment incontinence with melanophages in dermis. |
Dermoscopy is a valuable non-invasive tool for the diagnosis of DLE. Follicular plugging represents one of the most characteristic dermoscopic findings and correlates histologically with keratin-filled dilated follicles [3]. In our patient, the numerous follicular plugs created an appearance reminiscent of an upholstered surface, highlighting a striking visual clue that may facilitate recognition of DLE in advanced cases.
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The examination of the patient was conducted according to the principles of the Declaration of Helsinki.
The authors certify that they have obtained all appropriate patient consent forms, in which the patients gave their consent for images and other clinical information to be included in the journal. The patients understand that their names and initials will not be published and due effort will be made to conceal their identity, but that anonymity cannot be guaranteed.
REFERENCES
1. Nateghi A, Desrochers J. An uncommon presentation of discoid lupus suggesting systemic evolution. SAGE Open Med Case Rep. 2025;13:1–3.
2. Hocaoglu M, Denis M, Osei-Onomah SA, Valenzuela-Almada MO, Dabit JY, Duong SQ, et al. Epidemiology of cutaneous lupus erythematosus among adults over four decades (1976–2018):a Lupus Midwest Network (LUMEN) Study. Mayo Clin Proc. 2022;97:2282–90.
3. Wang Y, Zhu Y, Zhang C, Liu W. A scientometric study on research trends and characteristics of discoid lupus erythematosus. J Dent Sci. 2025;20:667–71.
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