[Skip to Content]
[Skip to Content Landing]

Erythematous Plaque on the Inferior Eyelid

Educational Objective
Based on this clinical scenario and the accompanying image, understand how to arrive at a correct diagnosis.
1 Credit CME

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).

Please finish quiz first before checking answer.

You answered correctly!

Read the answer below and download your certificate.

You answered incorrectly.

Read the discussion below and retake the quiz.

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

Survey Complete!

Sign in to take quiz and track your certificates

Buy This Activity

JN Learning™ is the home for CME and MOC from the JAMA Network. Search by specialty or US state and earn AMA PRA Category 1 CME Credit™ from articles, audio, Clinical Challenges and more. Learn more about CME/MOC

Article Information

Corresponding Author: Laura Z. Costamilan, MD, Department of Dermatology, Hospital Santa Casa de Curitiba, Praça Rui Barbosa, 694. 80010-030. Curitiba, Brazil (laura_zcostamilan@yahoo.com.br).

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.

References
1.
Huey  C, Jakobiec  FA, Iwamoto  T, Kennedy  R, Farmer  ER, Green  WR.  Discoid lupus erythematosus of the eyelids.  Ophthalmology. 1983;90(12):1389-1398.PubMedGoogle ScholarCrossref
2.
Pandhi  D, Singal  A, Rohtagi  J.  Eyelid involvement in disseminated chronic cutaneous lupus erythematosus.  Indian J Dermatol Venereol Leprol. 2006;72(5):370-372.PubMedGoogle ScholarCrossref
3.
Donzis  PB, Insler  MS, Buntin  DM, Gately  LE.  Discoid lupus erythematosus involving the eyelids.  Am J Ophthalmol. 1984;98(1):32-36.PubMedGoogle ScholarCrossref
4.
Ribero  S, Sciascia  S, Borradori  L, Lipsker  D.  The cutaneous spectrum of lupus erythematosus.  Clin Rev Allergy Immunol. 2017;53(3):291-305.PubMedGoogle ScholarCrossref
5.
Chong  BF, Song  J, Olsen  NJ.  Determining risk factors for developing systemic lupus erythematosus in patients with discoid lupus erythematosus.  Br J Dermatol. 2012;166(1):29-35.PubMedGoogle ScholarCrossref
6.
Lallas  A, Apalla  Z, Lefaki  I,  et al.  Dermoscopy of discoid lupus erythematosus.  Br J Dermatol. 2013;168(2):284-288.PubMedGoogle ScholarCrossref
7.
Ena  P, Pinna  A, Carta  F.  Discoid lupus erythematosus of the eyelids associated with staphylococcal blepharitis and Meibomian gland dysfunction.  Clin Exp Dermatol. 2006;31(1):77-79.PubMedGoogle ScholarCrossref
8.
Papalas  JA, Hitchcock  MG, Gandhi  P, Proia  AD.  Cutaneous lupus erythematosus of the eyelid as a mimic of squamous epithelial malignancies: a clinicopathologic study of 9 cases.  Ophthal Plast Reconstr Surg. 2011;27(3):168-172.PubMedGoogle Scholar
9.
Acharya  N, Pineda  R  II, Uy  HS, Foster  CS.  Discoid lupus erythematosus masquerading as chronic blepharoconjunctivitis.  Ophthalmology. 2005;112(5):e19-e23.PubMedGoogle ScholarCrossref
10.
Giménez-García  R, Sánchez-Ramón  S, De Andrés  A.  Discoid lupus erythematosus involving the eyelids.  J Eur Acad Dermatol Venereol. 2005;19(1):138-139.PubMedGoogle ScholarCrossref
If you are not a JN Learning subscriber, you can either:
Subscribe to JN Learning for one year
Buy this activity
jn-learning_Modal_LoginSubscribe_Purchase
If you are not a JN Learning subscriber, you can either:
Subscribe to JN Learning for one year
Buy this activity
jn-learning_Modal_LoginSubscribe_Purchase
With a personal account, you can:
  • Access free activities and track your credits
  • Personalize content alerts
  • Customize your interests
  • Fully personalize your learning experience
Education Center Collection Sign In Modal Right

Name Your Search

Save Search
With a personal account, you can:
  • Track your credits
  • Personalize content alerts
  • Customize your interests
  • Fully personalize your learning experience
jn-learning_Modal_SaveSearch_NoAccess_Purchase

Lookup An Activity

or

My Saved Searches

You currently have no searches saved.

With a personal account, you can:
  • Access free activities and track your credits
  • Personalize content alerts
  • Customize your interests
  • Fully personalize your learning experience
Education Center Collection Sign In Modal Right
Topics
State Requirements