Comedonic lupus, a rare variant of chronic cutaneous lupus erythematosus (CCLE): case series and literature review

Abstract

Background Cutaneous lupus erythematosus (CLE) is an autoimmune disease with several clinical presentations. The chronic form predominantly presents as discoid rashes but may present with less common morphological findings that can sometimes make diagnosis difficult. Comedonic lupus is a rare and underdiagnosed variant, with unknown etiology and still poorly defined treatment. MethodsThe report illustrates a series of five cases of patients diagnosed with comedonic lupus, and it reviews 18 cases previously published in the literature. ResultsThe clinical presentation is of comedonal lesions, mostly located on the face, making a differential diagnosis with other benign conditions such as acne vulgaris, Favre-Racouchot syndrome, and syringoma, emphasizing the importance of clinical practice and histopathology for diagnostic confirmation.Conclusions There is scarcity in the literature regarding the condition and therapeutic possibilities for these cases of comedonic lupus.

Carbamazepine‐induced comedonic lupus: A case report

“…Besides topical corticosteroids, benzoyl peroxide and both oral and topical retinoids, hydroxychloroquine has often been the preferred drug, with favourable clinical outcomes in documented cases. 2,3 Notably, in this case, resolution only occurred with cessation of carbamazepine (and commencement of levetiracetam) simultaneous to use of hydroxychloroquine. This patient failed to improve with antimalarial or retinoid therapy alone.…”

“…While some authors suggest the condition arises due to a breakdown of the pilosebaceous units, resulting in seborrheic areas and CD4 T-cell mediated epithelial hyperplasia, the definitive pathogenesis remains elusive. 2,3 Clinically, this disorder may masquerade as benign entities including trichoepithelioma, syringoma, Favre-Racouchot syndrome, nevus comedonicus, milia en plaque and acne vulgaris. 3 There is no gold standard treatment for CL.…”