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Female with slow spreading plaque on forehead
Last reviewed: December 2022
Author: Dr Ian Coulson, Consultant Dermatologist and Editor-in-Chief, 2022.
Edited by the DermNet content department
Background
This lady, in her mid-20s, has a slowly spreading plaque on her forehead. Her general health is good. Biopsy has excluded malignancy; it shows hyperkeratosis, follicular plugging, basal keratinocytes degeneration, and a dense perivascular chronic inflammatory infiltrate.
Describe the physical signs
There is a well-circumscribed plaque on a sun exposed area. Centrally, there is some atrophy. There is some scaling and follicular plugging. The lesion is red.
What is the best clinic-pathological diagnosis?
Coupled with the pathology, the features suggest discoid lupus erythematosus (DLE).
Suggest treatment options
The patient requires routine haematology, lupus serology, and urinalysis. If she is a smoker, this should be strongly discouraged.
Treatment strategies include:
- High sun protection factor sunscreens
- Advice regarding sun avoidance
- Potent or super potent topical steroids accurately to the affected area
- Consider using intralesional steroids if the above does not suppress inflammation
- Consider combining topical steroids with topical tacrolimus
- Consider antimalarial treatment — these tend to be less effective in smokers, hence the reason for discouraging smoking.