Adult-onset linear discoid lupus erythematosus on the forehead mimicking en coup de sabre: a case report

Abstract

Background: Linear cutaneous lupus erythematosus (LE) is an unusual form of LE-specific cutaneous condition, occurring in children and young adults. Due to its rarity, the diagnosis of linear cutaneous LE can be difficult and facial lesions can resemble linear morphea or en coup de sabre. Differential diagnosis of similar conditions along the lines of Blaschko must be differentiated from linear LE. Case presentation: We report a case of linear discoid LE on the forehead of an adult female Thai patient mimicking en coup de sabre. The dermatoscopy, histopathology and direct immunofluorescence findings were consistent with chronic cutaneous LE. Conclusions: As this patient demonstrated classic dermatoscopic features of LE, we emphasized that the diagnosis of linear cutaneous LE can be made by dermatoscopy. This is particularly beneficial for young self-conscious patients with facial lesions that are reluctant to perform skin biopsy.

Dermoscopy of discoid lupus erythematosus – a systematic review of the literature

“…[4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21] Dermoscopic features of cutaneous nonscalp DLE lesions (n = 129) were described in 11 studies (three original studies and eight case series/case reports). 6,[21][22][23][24][25][26][27][28][29][30] Two studies reported dermoscopic findings in labial DLE (n = 8), 21,31 one study presented dermoscopy of mucosal DLE (n = 3) 21 and one paper reported dermoscopic features of DLE involving the nail unit (n = 1). 32 The PRISMA flow chart of database search and literature selection is presented in Figure 1.…”

“…[5][6][7][9][10][11][13][14][15][16][18][19][20][21] They were also the most common finding in nonscalp DLE plaques (86/129 lesions; 66.7%). [21][22][23][24][26][27][28][29] Follicular plugs were statistically more common in nonscalp DLE plaques than in scalp lesions (P < 0.001).…”

“…Dermoscopic features of follicular openings in scalp and nonscalp DLE were reported in 17 4,7,[9][10][11][12][13][14][15][16][17][18][19][20][21] and nine papers, [21][22][23][24][25][26][27][28][29] respectively (Table 2). In scalp DLE, the most common findings were follicular keratotic plugs (mean frequency 47%), followed by absent follicular ostia (45.8%), fibrotic white dots (33.7%), yellow dots (21.1%), black dots (17.5%), and red dots (13.3%).…”

“…In scalp DLE, the most common findings were white structureless areas (mean frequency of 62.0%), followed by white scales 4,5,11,12,14,16,18,20,21 and 50/129 (38.8%) nonscalp DLE plaques (P = 0.88). 6,21,22,24,25 Honeycomb pigment pattern. Honeycomb pigment pattern is linked to chronic sun exposure of the balding scalp.…”

Reflectance Confocal Microscopy Applied to Linear (en Coup de Sabre) Morphea

“…ECDS morphea indicates a peculiar clinical presentation, characterized by an atrophic, indurated area on the paramedian forehead or the frontoparietal scalp, resembling a stroke from a sword. Although very typical, a sim-ilar clinical presentation could be observed in discoid lupus erythematosus, linear lichen sclerosus, and linear alopecia areata [5][6][7][8]. Diagnosis is based on histology; however, specific dermoscopic features have been identified, suggesting a role for noninvasive tool in diagnosis and management of morphea and lichen sclerosus [9].…”