Diagnosis Of Discoid Lupus Erythematosus Research Articles

Differential genotypes of TNF-α and IL-10 for immunological diagnosis in discoid lupus erythematosus and oral lichen planus: A narrative review.

Discoid lupus erythematosus and oral lichen planus are chronic systemic immune system-mediated diseases with unclear etiology and pathogenesis. The oral mucosa is the common primary site of pathogenesis in both, whereby innate and adaptive immunity and inflammation play crucial roles. The clinical manifestations of discoid lupus erythematosus on the oral mucosa are very similar to those of oral lichen planus; therefore, its oral lesion is classified under oral lichenoid lesions. In practice, the differential diagnosis of discoid lupus erythematosus and oral lichen planus has always relied on the clinical manifestations, with histopathological examination as an auxiliary diagnostic tool. However, the close resemblance of the clinical manifestations and histopathology proves challenging for accurate differential diagnosis and further treatment. In most cases, dentists and pathologists fail to distinguish between the conditions during the early stages of the lesions. It should be noted that both are considered to be precancerous conditions, highlighting the significance of early diagnosis and treatment. In the context of unknown etiology and pathogenesis, we suggest a serological and genetic diagnostic method based on TNF-α and IL-10. These are the two most common cytokines produced by the innate and adaptive immune systems and they play a fundamental role in maintaining immune homeostasis and modulating inflammation. The prominent variability in their expression levels and gene polymorphism typing in different lesions compensates for the low specificity of current conventional diagnostic protocols. This new diagnostic scheme, starting from the immunity and inflammation of the oral mucosa, enables simultaneous comparison of discoid lupus erythematosus and oral lichen planus. With relevant supportive evidence, this information can enhance physicians’ understanding of the two diseases, contribute to precision medicine, and aid in prevention of precancerous conditions.

Cross-sectional characteristics of pediatric-onset discoid lupus erythematosus: Results of a multicenter, retrospective cohort study

The incidence of systemic lupus in children with discoid lupus is unknown. This study assessed the baseline characteristics of patients with pediatric discoid lupus erythematosus (pDLE). Medical records at 17 sites were reviewed for pediatric dermatology and rheumatology patients with discoid lupus erythematosus. The inclusion criteria were clinical and/or histopathologic diagnosis of discoid lupus erythematosus with an age at onset of <18years. Baseline data were collected at the first documented visit. Outcomes included diagnosis of systemic lupus erythematosus (SLE) at the baseline visit using the 1997 American College of Rheumatology (primary) and the 2012 Systemic Lupus International Collaborating Clinics (secondary) criteria. Of the >1500 charts reviewed, 438 patients met the inclusion criteria. The cohort was predominantly female (72%) and racially/ethnically diverse. A diagnosis of SLE at the baseline visit (pDLE+SLE) was rendered in 162 (37%) patients using the American College of Rheumatology and in 181 (41%) patients using the Systemic Lupus International Collaborating Clinics criteria. Patients with pDLE+SLE were older at the time of rash onset (median, 12.9 vs 8.9years; P<.001), with shorter time from discoid lupus erythematosus onset to diagnosis, compared with patients with pDLE-only (median, 2 vs 7months; P<.001). Patients with pDLE+SLE were more likely to be female (P=.004), with generalized discoid lupus erythematosus and clinically aggressive disease, including end-organ involvement, positive serologies, and higher- titer levels of antinuclear antibodies (P<.001). Retrospective study. A diagnosis of discoid lupus erythematosus in adolescence should prompt thorough screening for SLE.

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

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.To describe the dermoscopic features of DLE and to correlate them with the histological findings, site and duration of DLE.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.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.We examined our patients at the time of presentation only without prospective monitoring and we had a relatively small sample size.Dermoscopy helps in the diagnosis of DLE at different body sites.

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

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. To describe the dermoscopic features of DLE and to correlate them with the histological findings, site and duration of DLE. 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. 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. We examined our patients at the time of presentation only without prospective monitoring and we had a relatively small sample size. Dermoscopy helps in the diagnosis of DLE at different body sites.

25656 Vulvar discoid lupus erythematosus: An unusual site for cutaneous lupus erythematosus

A 46-year-old woman presented with a 1-month history of a pruritic rash on trunk and face. On examination, she had well-defined erythematous scaly thin plaques photodistributed on the face, chest, ears, and neck. Biopsy demonstrated an interface dermatitis with increased dermal mucin. Laboratory evaluation was remarkable for a positive ANA 1:1280, but negative Ro/SS-A and La/SS-B antibodies. She was diagnosed with subacute cutaneous lupus erythematosus on the basis of clinical-pathologic findings. Tobacco cessation and strict sun protection were recommended, and she was prescribed hydroxychloroquine 200 mg twice daily and topical triamcinolone ointment. She was lost to follow-up during the COVID pandemic but was seen 6 months later with a persistent painful eruption of the vulva of several months’ duration. The patient had been hospitalized for this eruption and surgical debridement was performed which revealed a nonspecific neutrophilic infiltrate and tissue necrosis. Immunohistochemistry stain was negative for herpesvirus. She was treated with intravenous antibiotics and referred back to us. Upon her return visit, she had stopped smoking but was only taking hydroxychloroquine 200 mg daily. On examination, she had scarred erythematous patches on the labia minora and inguinal folds. Biopsy demonstrated a vacuolar interface dermatitis with superficial epidermal necrosis, dermal edema, and superficial and deep perivascular and periappendageal lymphoplasmacytic inflammation, favoring a diagnosis of discoid lupus erythematosus. We recommended increasing the hydroxychloroquine to 200 mg twice daily and continuing topical triamcinolone ointment.

Discoid Lupus Erythematosus of the Scalp in a Patient with Systemic Lupus Erythematosus: A Case Report with Complete Hair Regrowth

Scalp involvement with hair loss is common in systemic lupus erythematosus. Discoid lupus erythematosus may cause scarring alopecia, characterized by well-delimited erythematous plaques with scales, follicular hyperkeratosis and atrophy, which is considered a trichological emergency. Early diagnosis and treatment are necessary in order to prevent permanent hair loss. We describe a 44 years’ old female patient with systemic lupus erythematosus for 4 years, with multiple areas of occipitoparietal alopecia, erythematous plaques, atrophy, scales and some bloody crusts. Trichoscopy, histopathology and direct immunofluorescence led to the diagnosis of discoid lupus erythematosus. After 9 months treatment with thalidomide there was complete hair regrowth.

Clinical-therapeutic study on the efficacy and safety of thalidomide in the management of discoid lupus erythematosus. A single-centre, retrospective study.

Thalidomide is a second-line treatment for discoid lupus erythematosus (DLE). The efficacy of this treatment, the minimum effective doses, and safety is poorly documented in the literature. The aim of the study was to determine the efficacy and tolerance of thalidomide as first or second line of therapy for discoid lupus erythematosus. We present a retrospective single-centre study of 68 patients with DLE treated with thalidomide from 2003 to 2019. The inclusion criteria were the presence of clinical lesions suggestive of DLE, confirmed by histological examination and direct immunofluorescence. The mean age at diagnosis was 37.45years (range 18-65years). Thalidomide was started an average of 2.25years after the diagnosis of DLE, as second-line therapy in 85% of the cases (58 patients), and as first-line therapy in 10 patients (15%). Fifty-six patients improved with thalidomide (82%), 39 cases achieved complete remission and 17 partial remissions. The mean duration of follow-up with thalidomide was 8.4months (range 3-25months). Five patients discontinued thalidomide due to adverse events. The most frequent side effect was headache (23.5%). Thalidomide is effective and safe in DLE patients as first or second-line treatment with a good safety profile.

Practice‐based differences in paediatric DLE

The term ‘lupus’ refers to a range of related disorders. Discoid lupus erythematosus (DLE) is a form of lupus in the skin, which is rare in children. It can lead to disfiguring scarring. Some patients develop systemic lupus (SLE), a type of lupus that affects the whole body, which can lead to damage to multiple organs. Small studies have suggested that 25 to 30% of children with DLE develop SLE over time, but risk factors for this are not known. Early diagnosis and treatment of SLE are helpful. This study used a survey approach to compare practice patterns between two medical specialties, academic rheumatologists and dermatologists, in the United States and Canada, caring for children with DLE. The study aimed to identify areas of agreement but also practice-based differences between groups. Consensus (agreement) occurred when 70% or more of both specialties agreed. The authors found consensus that certain laboratory studies should be checked for all children at diagnosis of DLE. Both groups agreed that the presence of “other auto-antibodies besides ANA”, arthritis, or nephritis were high-risk features for SLE that should increase screening for systemic disease. There were no other agreed-upon risk factors for SLE, including those that have previously been shown in adults with DLE. Both groups agreed that first-line systemic therapy (whole body treatment) for widespread DLE should be hydroxychloroquine. The authors could not agree on which medications to use for resistant skin disease. Overall, the study found some areas of agreement but many areas of practice-based difference. More data in children with DLE is necessary to determine best practice approaches. The authors are completing a type of study called a retrospective cohort study that may help to fill these gaps.

The Role of Dermoscopy in Assessment of the Activity and Scarring Response in Discoid Lupus Erythematosus

Background:The diagnosis of Discoid Lupus Erythematosus (DLE) is usually made by clinical examination and by histopathology. Recently, dermoscopy has become an integral part in diagnoses of many inflammatory disorders and one of these is DLE.Aims:This research emphasizes the utility of dermoscopy in the assessing lesions of DLE from the point of activity of the disease.Patients and Methods:Thirty-one patients diagnosed with DLE were included in this study. The total number of examined lesions was 125 lesions. All of the lesions were assessed by dermoscopy at different stages of the activity of the diseases.Results:The dermoscopic features of DLE vary according to the stage of activity of the disease. There are characteristic dermoscopic features for the lesions of the scalp different from that of the body. In the active and early phase, the most common dermoscopic features were the presence of lesional and perilesional scales, follicular keratotic plugging, telangiectasia, arborized blood vessels, follicular red dots and perifollicular scales. In addition, there are less common dermoscopic features such as pigmentary changes, white rosettes and pinpoint white dots. For active scalp lesions, the follicular plugging and perifollicular scales were more prominent than that of the body DLE lesions. For inactive and late DLE lesions, the most significant dermoscopic changes were perifollicular whitish halos, variable patchy whitish hypopigmented areas, and the presence of white colored structureless areas.Conclusion:The present study provides new insights into the dermoscopic variability of DLE lesions at different levels of activity.

Diagnosis and treatment of canine discoid lupus erythematosus: Case report

The Lupus Erythematosus immune complex disease (LE) consists of a set of autoimmune dermatopathies that can manifest in two main clinical presentations: Systemic Lupus Erythematosus (SLE) and Discoid Lupus Erythematosus (DLE). The clinical diagnosis of DLE can be challenging, due to the variety of symptoms that can occur both in lupus and in other dermatological conditions, which interferes with the early diagnosis and consequently a delay in the treatment and improvement of the patient. This study aims to report the importance of histopathological examination in the definitive diagnosis for treatment and favorable prognosis of canine poodle with DLE. A poodle dog was attended at the Metropolitan Veterinary Polyclinic - HVM, presenting lesion in nasal area with previous treatments and no apparent improvment of the lesion. Laboratory and cytological exams were done to exclude other skin diseases. After an inconclusive result in the cytology, the histopathological examination was requested, to define the exact diagnosis and exclusion of other dermatopathies. The histopathological confirmed the diagnosis of Discoid Lupus Erythematosus. Treatment with corticosteroids at the dose of 1.0mg / kg, antioxidant vitamins and sunscreen was instituted. After 10 days, the dose increased to 2.5mg / kg, which is the immunosuppressive dose. The animal presented a response with a decrease in the crustal region of the lesion in the nasal plane.

Oral manifestations of lupus.

Mucosal involvement is commonly seen in patients with lupus; however, oral examination is often forgotten. Squamous cell carcinoma arising within oral lupoid plaques has been described, emphasizing the importance of identifying and treating oral lupus. We undertook a retrospective single-centre study looking at oral findings in patients attending our multidisciplinary lupus clinic between January 2015 and April 2016. A total of 42 patients were included. The majority of patients were female (88%) and had a diagnosis of discoid lupus erythematosus (62%). Half of the patients had positive oral findings, 26% had no oral examination documented, and 24% had documented normal oral examinations. Our findings suggest that oral pathology is common in this cohort of patients. Regular oral examination is warranted to identify oral lupus and provide treatment. Associated diseases such as Sjogren's syndrome may also be identified. Patients should be encouraged to see their general dental practitioners on a regular basis for mucosal review. Any persistent ulcer that fails to respond to treatment or hard lump needs urgent histopathological evaluation to exclude malignant transformation to squamous cell carcinoma.

Adult-onset Hydroa Vacciniforme: A Rare Occurrence or a Lymphoma Premonition?

Sir, Hydroa vacciniforme (HV) is a photodermatosis affecting children and adolescents, with papulovesicular eruptions and varioliform scars on face and other photoexposed parts.[1] Classically, the presentation is during childhood, though very rarely late onset cases have been described.[2] A subset of cutaneous T cell lymphoma, designated as HV-like lymphoma (HVLL) has also been described, which closely mimics HV.[3] A 42-year-old male patient, farmer by occupation, reported to dermatology outpatient department with history of severe burning sensation and swelling limited to face and scalp on sun exposure. This was followed by painful skin eruptions, which further progressed to become fluid filled within 3 to 5 days, followed by brown coloured scab formation and eventually depressed scars. The patient has been experiencing similar recurrent episodes since last 8 years, from February to August every year. The patient reported mild malaise and lethargy during vesicular phase of illness, but no other symptoms like fever or chills, burning in eyes, arthralgia, weight loss, easy fatiguability, bruising tendency, abdominal discomfort, or features suggestive of lymphoproliferative etiology. There was no family history of similar illness and patient denied intake of any photosensitizing drug. On cutaneous examination, few erythematous papulovesicles 0.2 cm to 0.4 cm in size with overlying crust were noted on right cheek [Figure 1]. Both cheeks and scalp also showed multiple brown to black-colored scabs, 0.5 cm to 1.2 cm in size [Figure 2]. Multiple well-defined, depressed, and varioliform scars ranging from 0.2 cm to 1.5 cm [Figure 1] were present on forehead, cheeks, nose, and scalp. No cervical, axillary or inguinal lymphadenopathy, and hepatosplenomegaly was noted. Cytological smears and blood samples were negative for human immunodeficiency virus (HIV), Epstein-Barr virus (EBV), and herpes simplex virus (HSV). Urine samples showed no fluorescence on Wood's lamp examination and urinary and fecal porphyrin levels were within normal limits. The hemogram, peripheral blood smear, ultrasonography of abdomen and lymph nodes revealed no abnormality. A provisional diagnosis of discoid lupus erythematosus (DLE), adult-onset HV, and HVLL was arrived at and a lesional skin biopsy was obtained. Biopsy revealed intracellular edema, basal cell vacoulization, and areas of necrosis in epidermis along with mixed neutrophilic and lymphocytic dermal infiltrate [Figure 3]. There were no atypical lymphocytes or viral inclusion bodies. The immunohistochemical (IHC) studies were negative for T-cell lymphoma (CD8 and CD56). These findings were consistent with the primary diagnosis of HV. Immunofluoresence for antinuclear antibody (ANA) was negative.Figure 1: Erythematous papulovesicles and multiple depressed varioliform scars of varying size on right cheekFigure 2: Brown-colored scabs with multiple varioliform scars on left cheekFigure 3: Hematoxylin and eosin (H and E) stain of biopsy from papulovesicle showing epidermal edema, basal and suprabasal cell vacuolization and keratinocyte necrosis (depicted by black arrow) (×10)The patient was advised strict photoprotection and oral hydroxychloroquine (400 mg/day) with beta-carotene supplements. On follow-up visits at 3 and 6 weeks, patient was experiencing lesser number of episodes with decreased clinical severity. The original description of HV has been credited to Bazin, though it was confused with erythropoietic protoporphyria in those reports.[4] The disease typically affects children and adolescents as a phototoxic rash and remits by early adulthood. Typically exacerbations are noted in spring to summer season due to higher proportion of UVA rays reaching earth during this time of year. HV is sometimes confused with HVLL due to similarities in clinical presentation and age group affected. However, HVLL is typically associated with EBV infection, higher clinical severity and disfigurement, involvement of non-photoexposed parts, e.g., scalp and trunk, as well as systemic complications.[5] Unlike HV, HVLL lesions are not induced by sun exposure and do not tend to resolve with age. Involvement of scalp in our patient did not correlate with HV because dense scalp hair normally provides considerable photoprotection, hence creating a suspicion of HVLL. This; however, could possibly be due to the occupation of patient which mandates prolonged sun exposure in open spaces, hence increasing the dose of photoexposure and clinical severity. Declaration of patient consent The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

Validity of trichoscopy in the diagnosis of primary cicatricial alopecias.

There are limited data on the validity of dermatoscopy in primary cicatricial alopecias (PCAs) and its subtypes, including lichen planopilaris and discoid lupus erythematosus. Trichoscopic features of PCAs, their prevalence, and validity were evaluated in this study. One hundred patients with PCA underwent dermatoscopy. Biopsy specimens were obtained after the site was marked with a dermatoscope. The control group comprised 100 patients with non-cicatricial alopecia and 100 normal individuals. Finally, the prevalence, sensitivity, and specificity of trichoscopic features were evaluated using SPSS and Stata software. The absence of follicular opening, perifollicular scale, and presence of one scarring pattern or white patch were sensitive and specific patterns in the trichoscopy of PCAs. The presence of tortuous branching vessels and follicular keratotic plugging was 100% specific for a diagnosis of discoid lupus erythematosus. Some trichoscopic features can help a dermatologist to differentiate between non-cicatricial alopecia and PCA. Moreover, a group of dermatoscopic features can be helpful in the diagnosis of PCA subtypes.

Myopericytoma as an unusual cause of scarring alopecia in a child

Myopericytoma is a benign tumor composed of myoid-appearing oval to spindle-shaped cells arranged in a concentric perivascular pattern of growth. It arises most commonly in the dermis or subcutaneous tissue of the extremities in adults, and presents as a well-circumscribed, slow-growing, painless firm tumor. We describe a case of myopericytoma with unusual clinical presentation as scarring alopecia in a 14-year-old girl without any underlying disease, who presented with a 2-month history of a pink patch with hair loss on her frontal scalp. Under the diagnosis of discoid lupus erythematosus, an incisional biopsy was also performed. The biopsy specimen revealed a myopericytoma characterized by a subcutaneous large vein-like structure surrounded by spindled, stellate, and cuboidal cells with multiple small branching vascular spaces. The overlying dermis was fibrotic with dilated vessels and the number of hair follicles was decreased. No features of lupus erythematosus were noted and a lupus band test was negative. Total excision was performed. No recurrence occurred in the following 2 years.

Cutaneous lupus erythematosus manifesting as unilateral eyelid erythema and swelling

Unilateral eyelid involvement, as the only manifestation of discoid lupus erythematosus (DLE), is very rare. Here, we report the case of a 41-year-old woman who presented with erythema and swelling of her left upper eyelid, which was initially misdiagnosed as cutaneous lymphoid hyperplasia. She had initially received radiotherapy at another institute for treatment. Our examinations established the diagnosis of DLE, and direct immunofluorescence confirmed this diagnosis. The skin lesion improved after treatment with topical steroids and oral hydroxycholoroquine.

Palpebral Involvement as a Presenting and Sole Manifestation of Discoid Lupus Erythematosus

A 28-year-old woman presented with a 2-year history of idiopathic, chronic blepharitis unresponsive to several courses treatment of corticosteroid eye drops. Physical examination was notable for edematous, erythematous plaques of the lower eyelids with madarosis in the absence of preceding skin scarring. Biopsy specimen was obtained and diagnosis of discoid lupus erythematosus (DLE) was made. DLE is a chronic, cutaneous disease that is clinically characterized by a malar rash, acute erythema, and discoid lesions. Localized DLE occurs when the head and neck only are affected, while widespread DLE occurs when other areas are affected, regardless of whether disease of the head and neck is seen. Patients with widespread involvement often have hematologic and serologic abnormalities, are more likely to develop systemic lupus erythematosus, and are more difficult to treat. A number of skin diseases may be confused with DLE, such as psoriasis, seborrheic dermatitis, acne, rosacea, lupus vulgaris, sarcoidosis, Bowen's disease, polymorphous light eruption, lichen planopilaris, dermatomyositis, granuloma annulare, and granuloma faciale. Palpebral lesions may rarely be the presenting or sole manifestation of the disease and lower eyelid involvement is seen in 6% of patients with chronic, cutaneous lupus erythematosus. DLE should therefore be considered as a differential diagnosis in chronic blepharitis or madarosis that persists despite usual medical management and eyelid hygiene. The patient was treated successfully with hydroxychloroquine. The skin lesions resolved with minimal scarring.

Cicatricial alopecia: discoid lupus erythematosus

Chronic cutaneous lupus erythematosus consists of three major dermatologic diseases: discoid lupus erythematosus (DLE), lupus panniculitis/lupus profundus, and lupus tumidus (Table 1). DLE is estimated to be responsible for 50-85% of patients with chronic cutaneous lupus erythematosus. Scalp involvement is most often the presenting symptom. The clinical features and diagnosis of DLE, its pathophysiology and treatment, are reviewed.

Autoimmunity predicts prolonged survival in colon cancer patients undergoing GOLFIG biochemotherapy

14542 Background: A multi-center phase II trial has been designed to evaluate toxicity, anti-tumour and immune-biological activity of the bio-chemotherapy GOLFIG regimen in advanced colorectal cancer (A-CRC). Methods: The trial involved 46 patients (34/46 2nd line or more). The biweekly GOLFIG regimen consisted of gemcitabine (1,000 mg/m2, day 1), oxaliplatin (85 mg/m2, day 2), levofolinic acid (100 mg /m2, day 1,2) and 5-FU (400 mg/m2 as a bolus, and 800 mg/m2 as 24 hour infusion, days 1,2) followed by sc GM-CSF (100 μg, days 3 to 8) and sc IL-2 (0.5 X 106 IUs twice a day, days 9 to 14). Results: GOLFIG regimen was well tolerated and resulted very active (ORR = 56.5%; disease control = 91.3%), fulfilling the pre-selected (40–60%) target of activity, with a promising TTP [12.26 months, 95% CI; 9.2–15.2 mo.] and OS [18.76 months, 95% CI; 15.2–22.3 mo.]. We detected a significant rise in lymphocyte number and colon cancer-specific cytotoxic T cells (CTLs) paralleled by a reduction in suppressive T-regulatory CD4+CD25+ FoxP3+ lymphocytes -Treg. Self-limiting autoimmunity (AI) occurred in 6 (14%) patients. 1 patient developed cutaneous lesions, with pathological diagnosis of Discoid Lupus Erythematosus (DLE), while 5 other presented a mono / oligoarticular arthritis mainly localized at the knees, elbows, shoulders and fingers with signs of synovitis (pain and swelling) paralleled by a significant increase of inflammatory markers (ESR, C-RP and rheumatoid factor). Subgroup analysis disclosed a mean time to progression of 23.8 months (95% CI; 12.1–35.56 mo.) and an overall survival of 31.83 months (95% CI; 19.9–43.7 mo.) in the 6 AI patients, significantly longer than in patients who did not develop AI [TTP and OS respectively 10.52 (95% CI; 7.7–13.3) and 16.8 months (95% CI; 13.3–20.2)], P ≤ 0.0039 and 0.0080. 5/6 AI patients are still alive and 3 have so far achieved a survival of 37, 41 and 50 months. Conclusions: The GOLFIG regimen exerts immunological and anti-tumour activity and has manageable toxicity in A-CRC. The occurrence of AI is predictive of a favourable outcome. These results provided the rationale for a presently ongoing phase III trial aimed to compare the efficacy of GOLFIG vs. FOLFOX-4 regimen as first line treatment in A- CRC patients. No significant financial relationships to disclose.

Discoid Lupus Erythematosus Presenting as Unilateral Blepharitis

A 39-year-old man presented with a 4-month history of unilateral blepharitis that did not respond to conventional treatment. Punch biopsy confirmed the diagnosis of discoid lupus erythematosus. Unilateral blepharitis as the only presenting sign of discoid lupus erythematosus is uncommon but should be considered in the differential diagnosis in patients with asymmetric blepharitis.

Discoid lupus erythematosus presenting as acneiform pitting scars

A 32‐year‐old man presented with conspicuous acneiform pitting scars on the right nasolabial fold of 3 years’ duration (Fig. 1). He stated that the scars were preceded by erythematous plaques. Physical examination also revealed perilesional erythematous infiltration and telangiectasia. Tracing back the history, there was no malar erythema, oral ulcer, or arthralgia. A skin biopsy showed irregular acanthosis, follicular plugging, vacuolar degeneration of the basal cell layer with marked melanin incontinence, and heavy periadnexal mononuclear cell infiltration (Fig. 2a,b). Direct immunofluorescence studies displayed continuous granular deposition of immunoglobulin G (IgG) and C3 along the dermo‐epidermal junction. The hemogram, antinuclear antibody (ANA) test, complement, and urinalysis were within normal limits. Based on the histopathologic findings and a positive lupus band test, a diagnosis of discoid lupus erythematosus (DLE) was made.An atrophic plaque composed of conspicuous acneiform pitting scars with surrounding erythema and telangiectasia on the right nasolabial foldimage(a) Marked follicular plugging and perivascular and periadnexal mononuclear cell infiltrates (hematoxylin and eosin, ×40). (b) Vacuolar degeneration of the basal layer with melanin incontinence (hematoxylin and eosin, ×400)image