Skin-nontumor / Clinical dermatology
Other dermatoses
Lupus erythematosus - Chronic discoid lupus

Author: Mowafak Hamodat, M.D., MB.CH.B, MSc., FRCPC (see Authors page)

Revised: 15 July 2016, last major update August 2011

Copyright: (c) 2002-2016, PathologyOutlines.com, Inc.

PubMed Search: Lupus erythematosus - Chronic discoid lupus

Cite this page: Chronic discoid lupus erythematosus. PathologyOutlines.com website. http://pathologyoutlines.com/topic/skinnontumorlupuschronic.html. Accessed December 9th, 2016.
Definition / General
  • Distinct entity from systemic lupus erythematosus (SLE), despite similar names
  • No systemic manifestations, although 1 / 3 with SLE have discoid type lesions
  • Common, usually women; may be exacerbated by sunlight
  • Lupus profundus: preferential lymphocytic infiltration of subcutaneous fat
Clinical Features
  • Localized or generalized pattern
  • Only 1% with localized variant develop systemic disease versus 5% with generalized variant
  • May become worse during spring/summer
  • Sharply circumscribed erythematous, atrophic or hyperkeratotic, shiny and scaling plaques on face, neck, scalp, arms or trunk
  • Plaques may have follicular keratotic plugs
Micro Description
  • Follicular hyperkeratosis, epidermal atrophy and acanthosis with degeneration of basal layer, periadnexal lymphocytic infiltrate
  • May have flask-shaped plugs of stratum corneum filling follicular orifices
  • Older lesions have thick and irregular basement membranes
  • Usually reticular dermal mucin
  • Rare plasma cells
Positive Stains
  • Lupus band test - IgG, IgM, C5b-C9 (by direct immunofluorescence) in clinically involved skin as irregular band at dermoepidermal junction
  • IgG and IgM in 50% in normal skin
  • Also positive for mucin stains (Alcian blue, colloidal iron)
Differential Diagnosis
  • Verrucous and hyperkeratotic chronic discoid lupus lesions on upper extremities resemble hypertrophic lichen planus or keratoacanthoma
  • Also polymorphous light eruption, chronic dermatitis, Jessners lymphocytic infiltrate of skin