Dermoscopic criteria of discoid lupus erythematosus: An observational cross-sectional study of 28 patients

Abstract

Background: Discoid lupus erythematosus (DLE) affects mainly the head and neck and lesions heal with scaring. Early diagnosis of DLE is crucial; dermoscopy may enable early diagnosis and help to assess the prognosis of well-established lesions. Aims: To describe the dermoscopic features of DLE and to correlate them with the histological findings, site and duration of DLE. Material and Method: This study included 28 patients diagnosed as DLE based on clinical and histopathological examination. We examined the lesions clinically, dermoscopically and histopathologically. Evaluated dermoscopic variables were based on data in the available literature and on our observations. Results: Whitish scales (89.3%), arborizing blood vessels (85.7%), follicular plugging (82.1%), and pigmentation (82.1%) were the commonest dermoscopic findings. Radial arrangement of arborizing blood vessel in between a radially arranged perifollicular whitish halo (starburst pattern) (39.3%) was noticed for the first time in this study. Rosettes (57.1%) were also seen. There was significant agreement between many dermoscopic and pathological findings with high sensitivity and specificity of many dermoscopic variants in the diagnosis of DLE. Follicular plugging, perifollicular whitish halo, starburst pattern, follicular red dots and rosettes were detected in early stages of the disease but structureless whitish areas and telangiectasia need more time to develop. Limitations: We examined our patients at the time of presentation only without prospective monitoring and we had a relatively small sample size. Conclusion: Dermoscopy helps in the diagnosis of DLE at different body sites.

Dermoscopic Features of Acute, Subacute, Chronic and Intermittent Subtypes of Cutaneous Lupus Erythematosus in Caucasians

“…Several studies have focused on the use of dermoscopy in the diagnosis of DLE [ 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 ]. DLE was found to present with follicular plugs, white perifollicular halos, white scaling, speckled pigmentation, white structureless areas and linear branched vessels [ 8 ].…”

“…Several studies have focused on the use of dermoscopy in the diagnosis of DLE [ 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 ]. DLE was found to present with follicular plugs, white perifollicular halos, white scaling, speckled pigmentation, white structureless areas and linear branched vessels [ 8 ]. Nevertheless, it is worth highlighting that many of the reports concerned DLE localized on the scalp, and the anatomical distinctiveness of this location may affect the dermoscopic (trichoscopic) findings [ 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 ].…”

“…Nevertheless, it is worth highlighting that many of the reports concerned DLE localized on the scalp, and the anatomical distinctiveness of this location may affect the dermoscopic (trichoscopic) findings [ 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 ]. In addition, a substantial percentage of studies on the dermoscopy of CLE were conducted in dark-skinned individuals [ 3 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 20 , 21 ]. Undoubtedly, the skin color may influence the clinical and dermoscopic presentation of many entities.…”

“…Dermoscopic findings reflect epidermal and upper-mid dermal changes and correlate directly to histopathological features [ 6 ]. Of all the clinical subtypes of CLE, the dermoscopic characteristics of CCLE, or in fact DLE, have been studied the most extensively [ 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 ]. On the other hand, data are scarce in the literature on the dermoscopic findings in ACLE [ 3 , 6 , 7 , 21 ] and SCLE [ 4 , 7 , 22 , 23 ].…”

“…On the other hand, data are scarce in the literature on the dermoscopic findings in ACLE [ 3 , 6 , 7 , 21 ] and SCLE [ 4 , 7 , 22 , 23 ]. Moreover, many of these reports concerned patients with dark skin phototypes (Fitzpatrick phototype III—V), and it remains unknown whether the results can be directly applied to the white population [ 3 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 20 , 21 ]. To the best of our knowledge, there are no reports in the English literature on the dermoscopic characteristics of LET.…”