Systemic lupus erythematosus with generalized chronic cutaneous (discoid) lupus erythematosus

A 24-year-old pregnant African-American woman had a 3-4 year history of chronic, scarring, hyperpigmented plaques on her scalp, face, trunk, and extremities. She complained of joint pain and fatigue. Clinical presentation, laboratory data, and histopathologic features were consistent with systemic lupus erythematosus in a patient with generalized chronic discoid lupus erythematosus. This subtype is a distinct lupus erythematosus subset that rarely develops renal disease and has a relatively benign but chronic course.     

Familial chronic discoid lupus erythematosus

We report on two patients (father and son) suffering from familial Lupus erythematosus chronicus discoides which could be proved clinically, histologically, and immunologically. Investigations on HLA revealed A-11, A-24, and B-35 for the father and A-24, B-13, and C-4 for the son.     

Verrucous lupus erythematosus: Ultrastructural studies on a distinct variant of chronic discoid lupus erythematosus

Ten patients with classic discoid lupus erythematosus of the face associated with verrucous, papulonodular lesions on the arms and hands were studied by electron microscopy. The ultrastructural findings on the verrucous lesions included apoptotic keratinocytes, intraepidermal lymphocytes, and gapping, detachment, and reduplication of the basal lamina. Also, tubuloreticular inclusion bodies were present in the endothelial cells. These observations, together with the clinical, histopathologic, and immunofluorescence findings, suggest that the verrucous lesions represent a rare, but distinct, variant of chronic discoid lupus erythematosus.     

Treatment of chronic discoid lupus erythematosus with thalidomide

Summary In an uncontrolled study the therapeutic effect of thalidomide on chronic discoid lupus erythematosus was investigated. In 24 patients (17 women, 7 men) with a history ranging from 0.5–32 years and unresponsive to any previous therapeutic measures, complete or substantial regression of the disease was observed in 19 cases (80%) after treatment with thalidomide. Side effects were somnolence, constipation, exanthema, oral dryness, and circulatory disturbances. None of these effects were serious.     

Hypertrophic discoid lupus erythematosus

Hypertrophic discoid lupus erythematosus is a distinct form of chronic cutaneous (discoid) lupus, which is characterized by hyperkeratotic plaques that typically are observed over the face, arms, and upper trunk. We present the case of a 43-year-old man with verrucous plaques that were distributed symmetrically over the face, who initially was treated with oral antibiotics and topical glucocorticoids for acne vulgaris. A biopsy specimen confirmed the diagnosis of hypertrophic discoid lupus erythematosus. The clinical and histopathologic features of this clinical variant are reviewed.