Angela Harrison

42, female , african american, married ,

History of sun sensitivity, no previous autoimmune diagnoses. Family history of systemic lupus erythematosus (SLE) in her mother. Non-smoker, drinks alcohol occasionally. Enjoys outdoor activities like hiking and gardening.

• Red, scaly patches on the face and scalp, particularly on the cheeks, nose, and forehead • Lesions started small but have gradually expanded and become raised • Some mild scarring in the affected areas • Worsening of lesions with sun exposure • Mild itching and discomfort in the affected areas • No joint pain, fatigue, or fever

Malar Rash

Lesions photosensitivity atrophic scarring alopecia

Several well-demarcated, erythematous (red), scaly plaques are observed on the cheeks, nose (malar area), and scalp. The lesions are round to oval in shape, with some areas showing hyperpigmentation and hypopigmentation in the center (due to scarring and healing).

1. Laboratory Results: o Complete Blood Count (CBC): Normal white blood cell count, no signs of anemia or infection. o Liver Function Tests (LFTs): Normal. o Serology for Autoimmune Markers:  ANA (Antinuclear Antibody): Negative (suggesting that the patient does not have systemic lupus erythematosus at this point).  Anti-dsDNA (double-stranded DNA): Negative (again, ruling out SLE).  Anti-Ro (SS-A) and Anti-La (SS-B): Negative (commonly associated with systemic lupus erythematosus but negative here).  Anti-Sm (Smith) Antibodies: Negative (not present in DLE). o Complement Levels: Normal (C3 and C4 levels), which suggests the absence of active systemic lupus erythematosus. 2. Skin Biopsy Results: A skin biopsy from an affected lesion on the cheek shows: o Hyperkeratosis: Thickening of the outermost layer of the skin (stratum corneum) with scale formation. o Atrophy of the Epidermis: Thinning of the epidermis, often seen in chronic lupus lesions. o Perivascular Inflammatory Infiltrate: Chronic inflammatory cells (predominantly lymphocytes and plasma cells) surrounding blood vessels. o Basal Layer Vacuolar Degeneration: Characteristic of discoid lupus erythematosus, where there is degeneration of the skin's basal layer. o Interface Dermatitis: A hallmark finding in lupus, where there is inflammation at the interface of the epidermis and dermis.

Systemic lupus erythematosus rosacea psoriasis ringworm seborhheic dermatitis

Discoid Lupus Erythematosus (DLE)

Hydroxychloroquine methotrexate glucocorticoids prednisone

Topical corticosteroids , topical calineurin inhibitors