Resident Dermatologist: Abe Korman, MD

Attending Dermatologist: Susan Massick, MD

Dermatopathologist: Catherine Chung, MD

HISTORY:

A 34 year old woman presents with a 12-year old history of an itchy rash on her face, scalp, and arms . She has used topical corticosteroids with minimal response.

Erythematous papules and plaques with scaling and dyspigmentation on the left forearm.

At low power, there is a thinned epidermis with compact stratum corneum (hyperkeratosis) and a mild dermal infiltrate.

At higher power, interface change is identified, with lymphocytes blurring the dermal-epidermal junction.

Follicular plugging – hyperkeratosis within a hair follicle – is present. In this view involvement of an adjacent acrosyringium by the infiltrate is also identified. The presence of melanophages along the basement membrane zone of the hair follicle indicates resolving interface inflammation of the follicular epithelium.

Interface change with lymphocytes that obscure the dermal-epidermal junction, pigment dropout (melanophages in the superficial dermis), and necrotic keratinocytes along the basement membrane zone are readily seen at high-power magnification.

What is the most likely diagnosis?

  1. Arthropod assault
  2. Discoid lupus erythematous
  3. Lichen planus
  4. Sarcoidosis
Discoid lupus erythematous