GP Quiz 13 – Case 9
A young woman presented in mid-summer with a 2-year history of a progressive unsightly skin rash on her face and ears.
What is the diagnosis?
Discoid lupus erythematosus
Describe the clinical features of this disorder.
All varieties of cutaneous lupus erythematosus (LE) are more common in females than in males, and they are more common in darker skin types. Discoid LE is the most common presentation and results in persistent red scaling plaques on light-exposed areas especially the nose, cheeks, lips, ears and scalp. The plaques heal with scarring.
Only 5% of patients with discoid lupus have systemic disease, which is more likely to present as a butterfly
macular facial rash, photosensitivity and patchy hair loss, associated with fever, fatigue, arthritis and other symptoms.
Which laboratory tests are helpful, if any?
Skin biopsy is most often used to diagnose cutaneous lupus in which there is a lichenoid tissue reaction and a band of immunoglobulins at the dermo-epidermal junction, detected by direct immunofluorescence of clinically involved skin. Rosacea shows follicular inflammation, which is sometimes granulomatous.
Complete blood count, antinuclear factor and extractable nuclear antigen tests are used to identify or monitor systemic disease.
What treatment would you recommend?
Refer the patient to a dermatologist to confirm the diagnosis and to plan management.
Education, and broad-spectrum, high protection factor sunscreens are an important part of the management of cutaneous LE.
Treatment includes potent topical steroids, pimecrolimus cream, oral antimalarials and a variety of immunosuppressive treatments.
This quiz was also published by New Zealand Doctor in June 2005.