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A 40-year-old healthy woman presented with an 8-year history of a slowly growing erythematous plaque on the left lower eyelid, with occasional discomfort. Physical examination revealed a single erythematous scaling plaque involving the left lower eyelid, including its border. Eyelashes were totally absent (Figure 1A). No other lesions were found after complete physical examination. Dermoscopy showed an erythematous background, telangiectatic vessels, whitish structureless areas, and whitish scales (Figure 1B). A 4-mm punch biopsy specimen was obtained (Figure 1C).
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B. Discoid lupus erythematosus
Histopathologic examination demonstrated an atrophic epidermis with parakeratosis, vacuolar alteration of the basal layer, and dense inflammatory infiltrate both in papillary and reticulate dermis, consistent with discoid lupus erythematosus (DLE) (Figure 1C). Antinuclear antibodies and double-stranded DNA serologic testing were negative. The patient was treated with high-potency topical corticosteroid for 10 days, followed by tacrolimus, combined with oral hydroxychloroquine 400 mg daily. At the 2-month follow-up visit, lesions had completely resolved (Figure 2).
Discoid lupus erythematosus is the most common clinical subtype of cutaneous lupus erythematosus. Clinically, it is characterized by erythematous and hyperchromic plaques with follicular plugging, which may lead to atrophy, pigmentary changes, and scarring. It primarily affects the ears, face, scalp, and neck.1 Eyelid involvement occurs in only 6% of cases, and DLE solely affecting the eyelids is exceptionally rare.2,3 Lesions involving areas below the neck, the disseminated form of DLE, occur in less than 20% of cases.4 The risk of DLE progressing to systemic lupus erythematosus is relatively low. Nonetheless, widespread DLE lesions, arthralgia and/or arthritis, nail changes, anemia, leucopenia, high erythrocyte sedimentation rates, and high titers of antinuclear antibodies increase this risk.5
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Corresponding Author: Laura Z. Costamilan, MD, Department of Dermatology, Hospital Santa Casa de Curitiba, Praça Rui Barbosa, 694. 80010-030. Curitiba, Brazil (email@example.com).
Published Online: April 18, 2018. doi:10.1001/jamadermatol.2018.0019
Conflict of Interest Disclosures: None reported.
Additional Contributions: We thank the patient for granting permission to publish this information.
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