Histopathology of the left labium and perianal area revealed acanthosis, parakeratosis, papillary dermal edema, pandermal infiltrate of neutrophils, giant cells, histiocytes, eosinophils, and plasma cells (Figure 2a,b). Periodic acid-Schiff stain for fungal profiles was negative, and Ziehl-Neelsen stain for acid-fast bacilli was negative.Complete hemogram, serum biochemistry, chest radiograph, and routine urinalysis were normal. Mantoux test was negative.Fecal occult blood and calprotectin tests as well as colonoscopy were within normal limits.

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In this nested, case-control study, we found a 2.00-fold increased risk of major depressive disorder among patients with discoid lupus erythematosus compared to controls without discoid lupus, using the All of Us database, a National Institutes of Health (USA) research program that prioritizes recruitment from demographic groups underrepresented in biomedical research. This is the first large-scale study of this association in a heterogeneous population and highlights the importance vigilance regarding the increased risk of depression in patients with discoid lupus erythematosus.