Comedonal variant of chronic cutaneous lupus erythematosus on the nose

Abstract

A thirty-year-old patient presented with an erythematous papule on the left nostril evolving for ten months. A clinical examination revealed an infiltrated, erythematous, well-limited plaque with a raised border, covered with multiple open and closed comedones. On dermoscopy, there was an erythematous background with some fine telangiectasias and horny plugs at the follicular orifices. A skin biopsy was performed, revealing orthokeratotic hyperkeratosis sinking into the follicular orifices dilated by sebum clumps with basal vacuolation associated with a subepidermal and periadnexal/perivascular lymphocyte band infiltrate. Direct immunofluorescence staining for immunoglobulin M was positive. The diagnosis of lupus comedones was retained, and the patient was put on topical tacrolimus 0.1% twice a day. A systemic damage assessment was negative. Our case highlighted, the importance of recognizing this rare variant of cutaneous lupus, confused with acne vulgaris, hence the delayed diagnosis, which may also be an early sign of a concomitant systemic involvement. Key words: Acne; Chronic Cutaneous Lupus Erythematosus; Comedonal Variant; Discoid Lupus Erythematosus