Discoid Lupus Research Articles

Skin CD4+ Trm cells distinguish acute cutaneous lupus erythematosus from localized discoid lupus erythematosus/subacute cutaneous lupus erythematosus and other skin diseases

BackgroundAlthough the contribution of aberrant CD4+ T cell signaling to systemic lupus erythematosus (SLE) is well established, its role in cutaneous lupus erythematosus (CLE) skin is largely unknown. Because the rate of systemic manifestations varies in each subtype, resident memory CD4+ T cells in lesions that are responsible for only skin-associated tissue responses may vary in each subtype. However, the role of CD4+ tissue-resident memory T (CD4+ Trm) cells in each CLE subtype remains unclear. ObjectivesTo analyze and compare CD4+ Trm cells and absent in melanoma 2 (AIM2) identified by smart RNA sequencing (Smart-seq) in CD4+ Trm cells from patients with acute CLE (ACLE), subacute CLE (SCLE), and localized discoid lupus erythematosus (localized DLE) lesions. MethodsWe performed Smart-seq to investigate differences in dermal CD4+ Trm cells between patients with ACLE and normal controls (NCs). Multicolor immunohistochemistry was utilized to measure the levels of AIM2 in CD4+ Trm cells present in the skin of 134 clinical patients, which included patients with localized DLE (n = 19), ACLE (n = 19), SCLE (n = 16), psoriasis (n = 12), rosacea (n = 17), lichen planus (n = 18), and annular granuloma (n = 15), as well as NCs (n = 18). ResultsThe Smart-seq data showed higher AIM2 expression in skin CD4+ Trm cells from ACLE lesions than NCs (fold change >10, adjusted P < 0.05). AIM2 expression in CD4+ Trm cells did not vary according to age or sex. AIM2 expression in CD4+ Trm cells was significantly lower in patients with ACLE (6.38 ± 5.22) than localized DLE (179.41 ± 160.98, P < 0.0001) and SCLE (63.43 ± 62.27, P < 0.05). In an overall comparison of ACLE with localized DLE and SCLE, the receiver operating characteristic curve for AIM2 expression in CD4+ Trm cells had a sensitivity of 100.00% and a specificity of 82.86% at a cutoff value of 18.26. In a comparison of ACLE with localized DLE, the sensitivity was 89.47%, and the specificity was 100.00% at a cutoff value of 12.26. In a comparison of ACLE with SCLE, the sensitivity was 100.00%, and the specificity was 75.00% at a cutoff value of 18.26. ConclusionsThe number of CD4+ Trm cells is increased in lesions of SCLE and localized DLE compared to ACLE, suggesting that CD4+ Trm cells may have a more crucial role in persistent lesions of SCLE and localized DLE. In addition, AIM2 expression in CD4+ Trm cells discriminates patients with ACLE from those with localized DLE and SCLE.

Disseminated Superficial Porokeratosis Mimicking Disseminated Discoid Lupus Erythematosus: An Unusual Presentation

Disseminated Superficial Porokeratosis Mimicking Disseminated Discoid Lupus Erythematosus: An Unusual Presentation

Platelet Rich Plasma for the Treatment of Scarring Alopecia Due to Discoid Lupus Erythematosus.

Platelet-rich plasma (PRP) is an autologous concentration of plasma from a patient&rsquo;s blood containing platelets up to 7 times higher than normal plasma. Originally indicated to improve connective tissue regeneration in orthopedic surgery, PRP has also proven to be advantageous in the treatment of androgenic alopecia (AGA), alopecia areata (AA), and other forms of non-scarring alopecia.

Buccofacial Manifestations of Systemic Lupus Erythematosus and Role of the Oral Surgeon in its Diagnosis and Management: Case Report and Review of the Literature

Systemic lupus erythematosus (SLE) is a chronic multi-system autoimmune disease with very heterogeneous clinical and serological manifestations. SLE is a relatively rare and more frequent disease in women. Clinical criteria such as photosensitivity, malar rash, neurological, articular and visceral manifestations are redefined. Among the immunological criteria, the ANA, anti-dsDNA, anti-Sm and anti-phospholipid antibodies are currently considered. Oral lesions are frequently identified in patients with SLE. They include oral ulceration, discoid lupus, lichenoid lesions, erythematous areas, and leukoplastic plaques. Secondary Sjögren's syndrome may develop. A high prevalence of periodontitis was also detected. Other oral and facial manifestations are reported, such as plaque calcification, joint damage and angioedema.Through our personal case, the role of the oral surgeon seems indisputable in the diagnosis and the management of patients with SLE.

The presence of mast cells in lichen planopilaris and discoid lupus erythematosus of the scalp: A quantitative study.

Histopathologic differentiation of lichen planopilaris (LPP) and discoid lupus erythematosus (DLE) as two common causes of primary cicatricial alopecias remains challenging. We performed a histopathologic study on a case series of LPP and DLE specimens to investigate the number, distribution, and morphology of mast cells as indices for differentiation of these two entities. H&E investigation and Giemsa staining for the detection of mast cells was performed. A total of 74 cases comprising 50 cases of LPP and 24 cases of DLE were assessed. The mean mast cell count and percentage were significantly higher in LPP group (p < 0.001). Mean degranulated mast cell count and the mean intact mast cell count were also significantly higher in LPP patients (p < 0.001). Most of the specimens, 58 (78.4%), showed both perifollicular and perivascular distribution of mast cells without significant difference between two groups. The morphology of mast cells was predominantly round-oval in 85.5%, predominantly fusiform in 13.5% with more frequent fusiform morphology in DLE group. The mast cell count detected by Giemsa staining could assist pathologists in distinguishing between LPP and DLE.

Horizontal Histopathology Correlation with In Vivo Reflectance Confocal Microscopy in Inflammatory Skin Diseases: A Review

Horizontal histopathological sections (HHSs) have been reported to show a strong correlation with images obtained via in vivo reflectance confocal microscopy (RCM), as both reflect the same horizontal plane of the skin. Although vertical histopathology remains the diagnostic gold standard for most neoplastic and inflammatory skin diseases, HHSs represent a useful tool to validate the RCM features of some inflammatory disorders, including psoriasis, discoid lupus erythematosus, and eczema. The aim of the present review is to summarize the state of the art on the existing correlations between HHS and RCM in this field and to emphasize that RCM may represent a useful diagnostic tool to discriminate between diseases with similar clinical presentations.

Immune-enhancing agents in autoimmune skin diseases – A review

Immunosuppressive drugs are the main stay of treatment for autoimmune dermatoses. The main disadvantage of these drugs is the increased susceptibility to life-threatening infections. Hence, in recent years, there has been an enthusiastic search for newer groups of drugs that can reduce this risk. Immune enhancing agents are considered as the key players of future. Immune enhancers function by activating various elements of the immune system and thereby amplifying the immune responses. They can be specific or non-specific in action. The main autoimmune dermatoses where the benefits of these drugs have so far been utilized include alopecia areata, vitiligo, psoriasis, lichen planus, and discoid lupus erythematosus. Immunostimulants are available in both topical and systemic forms. Topical immune- enhancing agents include contact sensitizers (diphenylcyclopropenone, dinitrochlorobenzene, and squaric acid dibutyl ester), anthralin, topical zinc, and interferons. Systemic agents include levamisole, zinc, probiotics, and so on. The exact mechanism of action of some of these drugs and other autoimmune conditions where they can be benefited is not completely understood. Another therapeutic agent that may come up in the future is individualized vaccines. Let us look forward to the days when individualized vaccines work wonders in the management of autoimmune diseases.

Implications of Dermoscopy and Histopathological Correlation in Discoid Lupus Erythematosus in Skin of Color.

Background:Discoid lupus erythematosus (DLE) is chronic dermatosis manifests as scaly indurated plaques with erythema and peripheral hyperpigmentation. Few cases progress to systemic lupus erythematosus. Differentials include lichenoid photo dermatitis, Jessner's lymphocytic infilterate, and polymorphus light eruptions. It is difficult to assess the activity clinically. Histopathology is characteristic and evaluation of disease activity is possible. Dermoscopy is a useful diagnostic method in many dermatoses. Dermoscopy is reflection of histological changes. Hence, dermoscopic features may act as a tool for activity assessment. Here authors have pursued dermoscopic and histopathological correlation in DLE lesions to assess the activity of disease.Aims:To study dermoscopic features in DLE and correlate the patterns with histopathological changes in skin of color.Method:This study was conducted in a tertiary hospital. Clinically suspected and histopathologically proven lesions of DLE were enrolled in this study. The target lesion was marked and sent for biopsy after performing dermoscopy. Activity of the lesion was assessed on the basis of histopathological features. SPSS statistics for windows v20.0 (SPSS Inc, Chicago, USA) was used to analyze data. Chi-square and Fisher's χ2 test was used to statistically signify association. Cohen's kappa coefficient was used to determine the agreement.Results:Study included 110 patients with Fitzpatrick skin type IV-V having 120 lesions. Follicular keratotic plug [73 (60.8%)] and peri-follicular whitish halo [65(54.1%)] were commonly found in dermoscopy. Blue-gray and brown dots, telangiectasia, follicular red dots, white rosettes and white areas include other features. Interface dermatitis, peri-appendageal infilterate, melanin incontinence, melanophages and fibrosis were noted in histopathology. Perfect agreement was observed in follicular plugs.Conclusion:Dermoscopy patterns were well correlated with histopathological changes. Thus dermoscopy played an important role in assessing the activity of lesion.

Efficacy of antimalarial agents to prevent the progression of discoid lupus erythematosus to systemic lupus erythematosus: A retrospective cross-sectional study.

Discoid Lupus Erythematosus (DLE) patients have the potential to developing Systemic Lupus Erythematosus (SLE) at a later time. The prescription of antimalarial agents might be beneficial to prevent this progression but the validated data is still lacking. Our study aimed to explore whether antimalarial agent could slow progression to SLE in DLE patients, adjusting for other potential confounders. We retrospectively studied 65 patients who were diagnosed as DLE and attended the outpatient clinic at King Chulalongkorn Memorial Hospital, Bangkok, Thailand, between January 1, 2017 and December 31, 2020. We reviewed medical records including history of DLE, SLE signs and symptoms, laboratory findings and treatment options. Over a total of 458.73 person years (PY), 19 patients (29.23%) eventually progressed to SLE within approximately 1 year. Of these, 15 patients had widespread lesions whereas only 4 patients presented with localized form. The prescription of antimalarial drug was associated with delayed SLE progression in our cohort. Other parameters such as generalized form (IRR 6.243 (95% CI 1.450-26.872); P = 0.014), joint involvement (IRR 5.005 (95% CI 1.931-12.969); P = 0.001) and LE specific skin lesions (IRR 3.799 (95% CI 1.220-11.825); P = 0.021) were considered as strong risk factors in SLE development. Our study suggested that an antimalarial drug could postpone the SLE development in DLE patients.

Primary Localized Cutaneous Amyloidosis Presenting as Pigmented Papules Over Pinna.

Dear editor, Amyloidosis of the auricular concha is a rare type of primary cutaneous amyloidosis that affects the outer ear, generally not associated with other types of cutaneous amyloidosis or systemic diseases. Hereby, we report the first Indian case of pigmented papules over pinna due to cutaneous amyloidosis with no systemic disease. A 38-year-old female complained of pigmented papules on bilateral ear pinna for 6 months. Lesions were asymptomatic and she denied history of any topical application, photosensitivity, oral ulcers, or hair loss. Examination revealed multiple pigmented papules of 1–2 mm in diameter in the bilateral auricular concha [Figure 1]. The differential diagnosis of plane warts, seborrheic keratosis, comedones and discoid lupus erythematosus was considered.Figure 1: Multiple pigmented papules of 1–2 mm in diameter over left ear pinnaDermoscopy showed a white central hub pattern surrounded by brown pigmentation and white scar-like morphology [Figure 2a and b]. A punch biopsy from the papule showed a deposit of amorphous, homogeneous eosinophilic, PAS-positive material in the papillary dermis, widening of dermal papillae with hyperkeratosis and acanthosis of epidermis corroborating with diagnosis of cutaneous amyloidosis of the auricular concha. A Congo red stain showed an orange-red deposit [Figure 3a and b]. Complete hemogram, renal function test and liver function test were normal. Urine examination for Bence Jones proteins, immunoglobulin profile for multiple myeloma and antinuclear antibody test were negative. Lesions resolved in 5 months with topical tretinoin 0.1%.Figure 2: (a) Dermoscopy (Dinolite Dermoscope polarized mode, ×50 magnification) showing white central hub pattern surrounded by brown pigmentation (black arrow). (b) Dermoscopy (Dinolite Dermoscope polarized mode, ×50 magnification) showing white scar-like morphology (black circle)Figure 3: (a) Hyperkeratosis and acanthosis of the epidermis with amorphous, homogeneous eosinophilic material in papillary dermis with the widening of dermal papillae (Hematoxylin and eosin stain 10×). (b) Orange-red deposit of amyloid in the papillary dermis (Congo red stain 10×)In 1988, Hicks et al.,[1] first reported amyloidosis of ear pinna in four adult patients that were not associated with other cutaneous amyloidosis lesions and proposed that the disorder was a new type of primary cutaneous amyloidosis. Bakos et al.,[2] considered it to be a topographic variant of lichen amyloidosis. It mainly affects women between 40-70 years of age, appears asymptomatic to pruritic small papules that can be normochromic, yellowish, erythematous, or pigmented and located anywhere on the outer ear, mainly in the auricular concha. Kelmens et al.,[3] reported a case of multiple myeloma with heaped lesions in the external auditory meatus. In our case, there were no abnormal laboratory findings suggestive of systemic disease. According to the filamentous degeneration theory, degenerated keratinocytes are discharged into the dermis, and cytokeratins are converted into amyloid-K.[4] Few similar reported cases suggest the collagenous nature of the material, as they were stained with Verhoeff-van Gieson and Periodic acid-Schiff and not with Congo red, and the lesions were called collagen papules of the auricular concha.[5] The most characteristic dermoscopic finding of primary cutaneous amyloidosis is a central hub, which could be either white or brown, surrounded by various configurations of pigmentation, including fine radiating streaks, leaf-like projections, and bulbous projections. Dermoscopic and histological correlation of amyloidosis is tabulated in Table 1. Dermoscopy helped us to rule out our clinical differentials such as discoid lupus erythematosus, milia, seborrheic keratosis, and plane warts.Table 1: Dermoscopic features of amyloidosis and their histological counterpartPrimary cutaneous amyloidosis of ear pinna is a rare entity but should be considered in the differential diagnosis of pigmented papules of the pinna. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

Dendritic cells may help differentiate discoid lupus erythematosus alopecia from lichen planopilaris.

IntroductionPrimary cicatricial alopecia (PCA) encompasses a heterogeneous group of inflammatory diseases characterized by the replacement of hair follicle structures by fibrous tissue. Discoid lupus erythematosus (DLE) and lichen planopilaris (LPP) are the most common causes of scarring alopecia. The distinction between both entities is often challenging because of significant clinical and histopathological overlap.AimWe hypothesized that dendritic cells which are implicated in PCA pathogenesis can provide a reliable histopathological clue to distinguish between these two entities.Material and methodsIn a retrospective cohort study including 51 patients diagnosed with LPP and DLE we mapped and quantified the distribution of dendritic cells. Cell count in lesional skin was performed on immunohistochemistry by using characteristic monoclonal antibodies to specific subpopulations of dendritic cells.ResultsWe demonstrated that almost all subpopulations of dendritic cells were highly expressed in lesional skin of discoid lupus erythematosus patients in comparison with lichen planopilaris ones.ConclusionsIn the light of this observation, dendritic cells might be used as an additional clue in differential diagnosis of PCA.

A Case of Facial Discoid Lupus Erythematosus (LE) with Oral Lichen Planus (LP): A Dig into Co-existence and LE-LP Overlap

A distinction between ‘co-existence of Lupus Erythematosus (LE) and Lichen Planus (LP)’ and ‘LE-LP overlap’ bears importance as the criterion for true overlap necessitates histological and immunological features of both LE and LP to be found in the same tissue specimen. However, in the present case report the lesions of LE and LP were present in two different sites. A 51-year-old male presented with a large erythematous scaly atrophic plaque on the right cheek with similar lesions on chin and lips for 10 years. He also had violaceous lesions on the bilateral buccal mucosa and a white lesion over the left buccal mucosa for three years. Discoid Lupus Erythematosus (DLE) and Oral Lichen Planus (OLP) were suspected. Dermoscopy of the facial plaque showed features consistent with DLE. Histopathology of the facial plaque confirmed the diagnosis of DLE, whereas the white plaque on the left buccal mucosa showed features of early invasive squamous cell carcinoma. Violaceous lesion over the right buccal mucosa showed features suggesting OLP. A Direct Immunofluorescence (DI) was also performed for the buccal mucosa to rule out the possibility of DLE with oral involvement, which turned out to be negative. Therefore, a diagnosis of synchronous presentation of DLE and OLP along with Squamous Cell Carcinoma (SCC) of the buccal mucosa was made and patient was treated with topical corticosteroids, systemic hydroxychloroquine and surgical intervention for the squamous cell carcinoma. It is also imperative that not only long standing cutaneous lesions, but also oral lesions like LP should be investigated and kept under observation to look for any early malignant changes.

Clinico-Epidemiology and Histopathologic Spectrum of Primary Scarring Alopecia: A Cross-Sectional Study.

Primary scarring alopecias (PSAs) are a rare group of dermatological disorders with overlapping clinical features. They result in permanent hair loss and significant psychological morbidity. To analyze the clinico-epidemiology of PSAs of the scalp, along with clinico-pathological correlation. We conducted a cross sectional, observational study including 53 histopathologically confirmed cases of PSA. Clinico-demographic parameters, hair care practices, and histologic characteristics were noted and statistically analyzed. Among 53 patients (mean age 30.9 ± 8.1 years, M: F 1:1.2, median duration 4 years) with PSA, lichen planopilaris (LPP) was most common (39.6%, 21/53), followed by pseudopelade of Brocq [30.2%, 16/53], discoid lupus erythematosus (DLE) [16.9%, 9/53], and non-specific scarring alopecia (SA) (7.5%, 4/53), while central centrifugal cicatricial alopecia (CCCA), folliculitis decalvans, and acne keloidalis nuchae (AKN) accounted for 1 case each. Forty-seven patients (88.7%) demonstrated predominant lymphocytic inflammatory infiltrate, while basal cell degeneration and follicular plugging were the commonest histological changes. Perifollicular erythema and dermal mucin deposition were noted in all patients with DLE (both P < 0.05). Nail involvement (P = 0.004) and mucosal involvement (P = 0.8) were more common in LPP. Single alopecic patches were characteristic of DLE and CCCA. Hair care practices (non-medicated shampoo > oil) had no significant association with the subtype of PSA. (P = 0.4). PSAs are a diagnostic challenge for dermatologists. Thus, histology and clinico-pathological correlation should be performed in all cases for proper diagnosis and treatment.

Dermoscopy of Oral Mucosal Lesions: Experience from a Tertiary Care Center in North India and Review of Literature.

Background:Patients with mucosal lesions form a significant number of routine outpatients presenting to the dermatology department where diagnostic confirmation using histopathological examination of mucosal biopsy is neither feasible nor warranted in every patient.Objective:To study the dermoscopic features of various mucosal lesions affecting the oral cavity and to assess the reliability of mucoscopy vis-a-vis clinico-laboratory findings.Materials and Methods:An observational, cross-sectional, hospital-based study was conducted over a period of 2 years from March 2019 to February 2021 in the dermatology outpatient department. Patients presenting with oral mucosal lesions, with or without associated cutaneous involvement, were recruited for mucoscopic evaluation after taking an informed written consent. A detailed history and clinical examination, with emphasis on mucocutaneous examination, was performed and findings were recorded on a standard predesigned proforma. Mucoscopy of oral mucosa was carried out using a handheld dermoscope as well as Universal Serial Bus connected video-dermoscope in both nonpolarized and polarized modes. The different mucoscopic features were seen at these sites, compared with each other, analyzed and findings were recorded. A diagnosis was made on the basis of mucoscopic findings and correlated with clinical diagnosis. The data was analyzed using appropriate statistical tests.Results:The mean age of patients was 34.3 years and the mean lesional duration was 68.2 weeks. Oral lichen planus (18.66%) was the most common disorder studied, followed by recurrent apthous stomatitis (16.00%), pigmentary lesions (12.66%), vascular disorders (12.00%), mucocele (5.33%), pemphigus vulgaris (4.66%), and discoid lupus erythematosus (4.66%).Conclusion:Dermoscopy in oral lesions facilitates the visualization of the mucosal surface and provides quick confirmation of diagnosis in various mucosal disorders with advanced diagnostic accuracy. Mucoscopy was found helpful in differentiating the oral ulcers, which are a presenting feature of various serious mucocutaneous disorders. Mucoscopy could be a helpful aid in diagnosing pigmented skin lesions and alleviating the apprehension regarding oral melanoma and serve as a screening tool in case of squamous cell carcinoma lips.Limitations:Confirmatory histopathological analysis and correlation with mucoscopic findings could not be established in our study.

Discoid lupus erythematosus like lesions after imatinib therapy: A rare case report

Discoid lupus erythematosus like lesions after imatinib therapy: A rare case report

English

BACKGROUND Cicatricial alopecia is the term used for permanent areas of hair loss due to destruction of hair follicles. It may occur due to a disease that primarily affects hair follicles or due to external causes that damages hair follicle secondarily. The common causes of primary cicatricial alopecia include discoid lupus erythematosus, lichen plano pilaris, pseudopelade of Brocq, folliculitis decalvans and folliculitis keloidalis. Exact diagnosis at an early stage will help to provide disease specific management at the earliest thus, preventing further progression of the disease. We conducted this study to assess the role of clinico-pathological correlation to find out the exact aetiology of primary scarring alopecia in our patients. METHODS We conducted a descriptive cross sectional study to find out aetiology of primary cicatricial alopecia based on clinical and histopathological findings of 50 patients who attended the outpatient department of Dermatology in our hospital. After a detailed history and clinical examination of scalp, biopsy of lesional scalp skin was taken in all patients. In relevant cases direct immunofluorescence study was also done. RESULTS Age of the patients ranged from 16-75 years. M: F ratio was 1:1.5. Hair loss, itching, scaling and scalp pain were the reported symptoms. Commonly affected sites were parietal and temporal areas. 76 % of patients had multiple lesions. Absent follicular ostia, follicular plugging, atrophy, pigmentary changes, scaling and telangiectasias were the commonly observed clinical scalp findings. 88 % of cases showed lymphocytic infiltrate on histopathology. After clinico-pathological correlation, 48% patients had discoid lupus erythematosus followed by follicular lichen planus in 28% and pseudopelade of Brocq in 20 % cases. Folliculitis decalvans and folliculitis keloidalis each were observed in 2 % cases of primary scarring alopecia. CONCLUSIONS Clinicopathological correlation is highly useful to make an early diagnosis in primary cicatricial alopecia. In our patients discoid lupus erythematosus was found to be the predominant cause. KEY WORDS Cicatricial Alopecia, Clinicopathological Correlation, Discoid Lupus Erythematosus, Lichen Planus

Discoid lupus erythematosus – a case report, diagnostic and therapeutic difficulties

Discoid lupus erythematosus is the most common clinical manifestation of lupus erythematosus. Characteristic features are erythematous plaques with follicular hiperkeratosis, clearly demarcated from surrounding skin, that resolve with atrophy and scarring, leading to significant aesthetic defects. The consequence of involving the scalp is cicatrical alopecia. On the ground of long lasting, untreated lesions squamous cell carcinoma (SCC) may develop. On the other hand SCC remains in the circle of DLE differentiation. We present diagnostic and therapeutic difficulties associated with DLE.

Moth eaten alopecia as a manifestation of group of skin diseases: Reporting a series of 100 cases

Background: The moth-eaten alopecia is a characteristic clinical pattern usually of multiple small ill-defined patches of hair loss that was originally used to describe alopecia in syphilis but it is not well reported in other skin diseases. Objective: To record all patients that present with moth eaten alopecia and to do full clinical evaluation and classification aiming to find skin diseases that initially or during the course of the disease present with this pattern of hair loss. Patients and methods: This is a descriptive observational study of a series of 100 patients with moth-eaten alopecia. The data were collected in Baghdad city from 2014 to 2021 with an age range between 8-45 years involving 72 males and 28 females. Full laboratory evaluation including scraping for fungal infection and skin biopsy were performed when its indicated and justified. Results: The results of this study showed that lichen planopilaris, was recognized in 32(32%) patients, their ranged from 20-45 years with a mean of 25, while males consisted 31(96.8%) and females 1(3.2%). Discoid lupus erythematous was identified in 26(26%) patients, their ages ranged from 18-48 years with a mean 30 years including 7(26.9%) males and 19(73.1%). Females. Alopecia areata was recognized in 11(11%) patients, their ages ranged from 8-25 years with a mean 17 years, among them 6 males (54.5%) and 5 females (45.5%). Chronic folliculitis presented in 9(9%) male patients, their ages ranged from 20-30 years with a mean 25 years. Striae distensea was seen and identified in 9 patients their ages ranged from 3-10 years with a mean 7 years, among them males 8(89%) and females 1(11%). Scalp morphea was detected in 7(7%) patients, their ages ranged from 5-34 years with a mean of 29 years among them 5(71.5%) males and 2 (28.5%) females. Tinea capitis was seen in 4(4%) male patients, their age ranged from 3-5 years with a mean age of 4 years. While Juicy Psoriasis was encountered in two male patients (2%). Their ages ranged from 7 and 15 years with a mean 11 years. Conclusion: This is the first study describing and evaluating moth eaten alopecia as a characteristic and unique pattern of hair loss for many dermatosis. lichen planopilaris, discoid lupus erythematous, chronic folliculitis, striae distensae like were among the commonest diseases that cause this type of hair loss. This work will provide an important differential and diagnostic tool for clinician in order to establish early diagnosis and treatment, thus preventing the progress of the disease and scarring.

Ocular Manifestations of Lupus Erythematosus

Background: Lupus erythematosus (LE) is a chronic autoimmune disease that elicits a type III hypersensitivity reaction in which antibody-immune complexes precipitate and causes further immune response. There are three types of LE: discoid, systemic, and drug-induced. Systemic lupus erythematosus (SLE) is among the most common and concerning of the three. SLE harms mostly the heart, joints, skin, blood vessels, liver, kidneys, and nervous system. In addition to systemic issues, LE uniquely manifests itself in and around the eye. Secondary Sjögren’s syndrome (SS) and severe dry eyes are common among LE patients. Currently, there is no cure for LE; patients are often treated with an immunosuppressant or antimalarials, such as hydroxychloroquine. Case Reports: A patient who appeared to have discoid lupus erythematosus (DLE) with secondary SS was referred to eye clinic by rheumatology for hydroxychloroquine screening. He presented with severe dry eyes. Treatment for dry eyes was initiated and screening for hydroxychloroquine toxicity was conducted. Another patient presented to the eye clinic for reduced vision in his right eye. He was diagnosed with systemic lupus with no treatment. Ophthalmic examination revealed a unilateral macular edema secondary to a central retinal vein occlusion likely to active systemic lupus. Immediate referral to rheumatology and ophthalmology was made. Conclusion: Since patients with LE may have many ocular manifestations, optometrists should be able to recognize them and ensure that the patient receives appropriate treatment. Communication with ophthalmology and rheumatology is important for the management of these cases. CE Notification: This article is available as a COPE accredited CE course. You may take this course for 1-hour credit. Read the article and take the qualifying test to earn your credit. Click here to Enroll (https://www.crojournal.com/ocular-manifestations-of-lupus-erythematosus)

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.