International Journal of Clinical & Medical Images

A 58-year-old patient, followed in cardiology for acute coronary syndrome under treatment, had erythematous plaques infiltrated from both cheeks and under-chin, evolving for 4 years. Dermatological examination showed violaceous erythematous plaques (Figure 1) with a hypopigmented center and hyperpigmented peripheral border and erythematosus, atrophic in both cheeks (A) as well as a violaceous plate on the chin (B), and another surmounted by multiple comedones on the conch of the ears (C). The dermoscopic examination revealed an erythematous background, a follicular hyperkeratosis producing corneal plugs and pseudo comedones (Figure 2: Blue circle) and a perifollicular whitish halo (Figure 2). A skin biopsy was in favor chronic lupus erythematosus. Routine biological examinations were normal. There were anti-nuclear antibodies at the rate of 1/640 with a speckled appearance. Evolution was good under 400 mg of hydroxychloroquine, application of dermocorticoid and rigorous photoprotection. Lupus erythematosus is an autoimmune disease with variable clinical aspects. We report a clinical presentation of chronic lupus erythematosus of unusual comedonian appearance. Lupus comedonian appears to be a new clinical and histological entity not reported in recent reviews of cutaneous forms of lupus. However, the dermoscopy can be of great help by showing black openings in pseudo-comedones and images of pseudo-grains of milium testifying to the folliculotrope character. Do not hesitate to think about it also before an eruption pruriginous acneiform located at the level of photo-exposed regions.A 58-year-old patient, followed in cardiology for acute coronary syndrome under treatment, had erythematous plaques infiltrated from both cheeks and under-chin, evolving for 4 years. Dermatological examination showed violaceous erythematous plaques (Figure 1) with a hypopigmented center and hyperpigmented peripheral border and erythematosus, atrophic in both cheeks (A) as well as a violaceous plate on the chin (B), and another surmounted by multiple comedones on the conch of the ears (C). The dermoscopic examination revealed an erythematous background, a follicular hyperkeratosis producing corneal plugs and pseudo comedones (Figure 2: Blue circle) and a perifollicular whitish halo (Figure 2). A skin biopsy was in favor chronic lupus erythematosus. Routine biological examinations were normal. There were anti-nuclear antibodies at the rate of 1/640 with a speckled appearance. Evolution was good under 400 mg of hydroxychloroquine, application of dermocorticoid and rigorous photoprotection. Lupus erythematosus is an autoimmune disease with variable clinical aspects. We report a clinical presentation of chronic lupus erythematosus of unusual comedonian appearance. Lupus comedonian appears to be a new clinical and histological entity not reported in recent reviews of cutaneous forms of lupus. However, the dermoscopy can be of great help by showing black openings in pseudo-comedones and images of pseudo-grains of milium testifying to the folliculotrope character. Do not hesitate to think about it also before an eruption pruriginous acneiform located at the level of photo-exposed regions.