Abstract
We report the case of a 49-year-old male with clinical and histological findings consistent with hypertrophic lupus erythematosus (HLE). HLE must be clinically and histologically differentiated from keratoacanthoma, hypertrophic lichen planus, squamous cell carcinoma and plaque type psoriasis. CD123 positivity and transepidermal elimination of elastin have recently been reported as tools to distinguish HLE. Interestingly, in this case, biopsies of two separate lesions failed to reveal these two features. The etiology of this discrepancy is unknown and further studies are needed to clarify the utility of CD123 positivity and transepidermal elimination of elastin in the diagnosis of hypertrophic lupus erythematosus.
Highlights
Hypertrophic lupus erythematosus (HLE) is a rare subset of discoid lupus erythematosus, characterized by erythematous, indurated, verrucous papules and nodules located on sun-exposed areas
Clinical diagnosis can be challenging as HLE can mimic psoriasis or even squamous cell carcinoma
Uitto et al described two histological patterns of HLE One resembled hypertrophic lichen planus, while the other was similar to keratoacanthoma[4]
Summary
Hypertrophic lupus erythematosus (HLE) is a rare subset of discoid lupus erythematosus, characterized by erythematous, indurated, verrucous papules and nodules located on sun-exposed areas. Report of case A 49-year-old, unemployed, white male presented with a three-year history of an expanding “rash”. The patient had a past medical history of hepatitis C. He denied a family history of skin or autoimmune diseases. Physical exam revealed multiple hyperkeratotic, verrucous papules and nodules with white, scaly, cribriform centers overlying patches of depigmentation, erythema and atrophy on his bilateral arms (Figure 1) and anterior legs. His face and scalp had several atrophic, depigmented patches.
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