A 37-Year-Old Male with an ‘Itchy’ Lesion on his Face

Differential Diagnosis

• Tinea corporis
• Lichen planus
• Discoid lupus erythematosus
• Sarcoidosis
• Basal cell carcinoma

Diagnosis

This patient was diagnosed with discoid lupus erythematosus (DLE), a disfiguring autoimmune skin disease and the most common form of chronic cutaneous lupus erythematosus.

Learnings/What to Look for

• DLE has a characteristic clinical appearance consisting of red, scaly plaques with resulting pigmentary changes and scars; the plaques are frequently found on the face and scalp
• Discoid rash is one of the 11 diagnostic criteria for systemic lupus erythematosus (SLE); 20% of patients with SLE will manifest discoid lesions. However, only 5% to 10% of patients with DLE demonstrate systemic involvement or will go on to develop SLE
• DLE most commonly afflicts women in the third and fourth decades of life, although it may occur at any age and in either gender
• Individuals of African and Hispanic descent are at increased risk, and there may be a positive family history of lupus or connective tissue disease

Pearls for Urgent Care Management and Considerations for Transfer
Patients with DLE should be counseled to employ sun-protection measures such as sunscreen, photoprotective clothing, brimmed hats, and avoiding exposure to the sun during peak hours

• Topical retinoids have been reported to be helpful
• Rarely, squamous cell carcinomamay rarely develop in chronic DLE scars, especially in sun-exposed areas

Acknowledgment: Images and case courtesy of VisualDx (www.VisualDx.com/JUCM).