Objective To describe the clinical characteristics, management and quality of life of psoriasis patients with and without coexistent lupus erythematosus (LE). Methods This retrospective cross‐sectional study uses data from the Malaysian Psoriasis Registry (MPR) from January 2007 to December 2018. Results Of 21 735 psoriasis patients, 34 (0.16%) had coexistent LE. The male to female ratio among psoriasis patients with coexistent LE was 1:5.8 versus 1.3:1 in patients with psoriasis but without LE. Nearly 70% presented with LE preceding psoriasis. Psoriasis patients with LE had an earlier age of psoriasis onset (27.56 ± 11.51 versus 33.31 ± 16.94 years, P = 0.006), a higher rate of psoriatic arthropathy (26.5% versus 13.0%, P = 0.02), and a significantly greater impairment of quality of life (Dermatology Quality of Life Index >10; 57.6% versus 40.3%, P = 0.04) compared with psoriasis patients without LE. The majority (87.5%) had systemic LE. The incidences of lupus nephritis (72.7% versus 40%) and hematological abnormalities (50% versus 20%) were higher among patients with LE preceding psoriasis compared with those with psoriasis preceding LE. Antinuclear antibody and double‐stranded DNA were positive in 59.4% and 28.1% of psoriasis patients with LE, respectively. Hydroxychloroquine triggered the onset of psoriasis in 7 (24.1%) patients. Patients with LE were more likely to receive systemic treatment for psoriasis compared with those without LE (30.3% versus 14.2%, P = 0.008). Conclusions Psoriasis patients with coexistent LE were uncommon, displayed a female preponderance, were more likely to have joint involvement, and had greater quality of life impairment than those without LE. LE preceded psoriasis in most of these patients, and systemic LE was the most common subtype.

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the lesion of the proximal medial right thigh. Suspecting dermatophytid, we decided to perform further investigation through RCM. In the RCM, evaluation of the groin and foot revealed several bright linear structures (mycelium), as well as some inflammatory cells were found scattered in the stratum corneum (Fig. 1c). Regarding the thigh lesion, no fungal structures were seen, but mild perivascular inflammatory infiltrate and spongiosis (dark areas in the epidermis, with broadband intercellular spaces) were appreciated (Fig. 2b), confirming the diagnosis of dermatophytid. Later, fungal culture revealed the presence of Trichophyton mentagrophytes. Therapy with oral itraconazole 100 mg every 12 h was started. After 4 weeks of treatment, all lesions vanished.A dermatophytid is an id reaction caused by an immunologic response to the fungal antigens that derive from the fungal pathogen, away from the primary skin lesion. Normally, it appears 1 or 2 weeks after the primary infection and can cause significant pruritus. 2 Upon direct microscopic evaluation and fungal culture, the lesions are pathogen-negative. The id tends to resolve after the primary lesion has been treated, as was the case of our patient. 2 The RCM offers a prompt, easy, and noninvasive technique for the diagnosis of dermatophytic infections and id reactions, reducing the number of skin scrapings or biopsies. Moreover, RCM offers the possibility to repeat the exam on different body sites and at different times to evaluate therapeutic response.More comparative studies including histopathologic and RCM evaluation should be made to confirm the utility and sensitivity of RCM for fungal infections.