DermDx: Red Rash on Nose

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A 27-year-old Hispanic man is referred for evaluation of a facial rash. He states that the eruption began 4 months ago and was preceded by a severe sunburn. The patient is otherwise in good health and takes no oral medications. He denies a family history of chronic skin disease. Physical examination reveals a well-demarcated erythematous plaque on his nose and a similar lesion on his right upper cheek. Dilated follicles are noted within both lesions.

Lupus is Latin for wolf and is a centuries-old nomenclature applied to a condition that appeared to devour the skin (as would a wolf).1,2 In 1872, Kaposi distinguished the systemic form of lupus from the discoid type. In 1981, discoid...

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Lupus is Latin for wolf and is a centuries-old nomenclature applied to a condition that appeared to devour the skin (as would a wolf).1,2 In 1872, Kaposi distinguished the systemic form of lupus from the discoid type. In 1981, discoid lupus erythematosus (DLE) was divided into 3 subtypes: localized DLE, generalized DLE (lesions arising above and below the neck), and hypertrophic DLE, which is characterized by hyperkeratotic plaques.

Localized DLE presents as a well-defined annular patch or plaque with varying degrees of erythema. Characteristic findings include location on the face, ears, and scalp; dilated follicular orifices; and pigmentary changes.3 When present on the scalp, DLE can result in scarring alopecia. Histologic features include follicular plugging, liquefaction degeneration of the basal layer, and inflammatory infiltrates about blood vessels and appendageal structures.

First-line therapies for DLE include sun protection, topical and intralesional steroids, topical calcineurin inhibitors, and hydroxychloroquine.4  

Brittany Spinosa-Weber, PA-C, is on staff at the DermDox Centers for Dermatology with offices in Bethlehem and Sugarloaf, Pennsylvania. Stephen Schleicher, MD, is director of the DermDox Dermatology Centers, associate professor of medicine at Geisinger Commonwealth Medical College, and clinical instructor of dermatology at Arcadia University and Kings College.

References

1. Felten R, Lipsker D, Sibilia J, Chasset F, Arnaud L. The history of lupus throughout the ages. J Am Acad Dermatol. 2022;87(6):1361-1369. doi:10.1016/j.jaad.2020.04.150

2. Lupus Foundation of American. The history of lupus. Accessed February 1, 2023. https://www.lupus.org/resources/the-history-of-lupus

3. Elman SA, Joyce C, Nyberg F, et al. Development of classification criteria for discoid lupus erythematosus: results of a Delphi exercise. J Am Acad Dermatol. 2017;77(2):261-267. doi:10.1016/j.jaad.2017.02.030

4. McDaniel B, Sukumaran S, Koritala T, et al. Discoid lupus erythematosus. [Updated 2022 Aug 29]. In: StatPearls [Internet]. StatPearls Publishing; 2022 Jan-. https://www.ncbi.nlm.nih.gov/books/NBK493145/

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