Case: Female with slow spreading plaque on forehead

Home

Cases

Female with slow spreading plaque on forehead

Last reviewed: December 2022

Author: Dr Ian Coulson, Consultant Dermatologist and Editor-in-Chief, 2022.

Edited by the DermNet content department

Give us feedback

Background

This lady, in her mid-20s, has a slowly spreading plaque on her forehead. Her general health is good. Biopsy has excluded malignancy; it shows hyperkeratosis, follicular plugging, basal keratinocytes degeneration, and a dense perivascular chronic inflammatory infiltrate.

Describe the physical signs

There is a well-circumscribed plaque on a sun exposed area. Centrally, there is some atrophy. There is some scaling and follicular plugging. The lesion is red.

What is the best clinic-pathological diagnosis?

Coupled with the pathology, the features suggest discoid lupus erythematosus (DLE).

Suggest treatment options

The patient requires routine haematology, lupus serology, and urinalysis. If she is a smoker, this should be strongly discouraged.

Treatment strategies include:

High sun protection factor sunscreens
Advice regarding sun avoidance
Potent or super potent topical steroids accurately to the affected area
Consider using intralesional steroids if the above does not suppress inflammation
Consider combining topical steroids with topical tacrolimus
Consider antimalarial treatment — these tend to be less effective in smokers, hence the reason for discouraging smoking.

Other cases

All cases