Maculopapular Skin Disease
A patient presents to you for evaluation of this lesion, which has been on his skin for 6 months. The lesion began as a red papule with a thick adherent scale (see Color Atlas, Figure 10). Since that time, it has progressed to the current pictured lesion with raised borders and scars. There has been no improvement with use of topical glucocorticoids, which the patient borrowed from a friend. What is the best course of action for this patient at this time?
|D||Vitamin E ointment|
|E||Wide surgical excision with regional lymph node dissection|
1). The patient has discoid lupus erythematosus (DLE) or chronic cutaneous lupus erythematosus.
2). It is characterized by discrete lesions most often on the face, scalp, or ears.
3). The lesions are usually erythematous papules or plaques with a thick scale that occludes hair follicles.
4). The lesions persist for years and grow slowly. Less than 5% of patients with DLE meet criteria for systemic lupus erythematosus (SLE), although skin lesions are common in patients with SLE.
5). Chronically, the lesions evolve to look similar to the one pictured.
6). Treatment consists of topical or intralesional glucocorticoids.
7). If that is ineffective, systemic therapy with an aminoquinoline antimalarial may be indicated. Systemic glucocorticoids or immunosuppressives are not indicated for localized disease.
8). Although malignant melanoma may take on myriad appearances, the location, progress, and description of this lesion is more suggestive of discoid lupus, therefore, surgical excision and lymph node dissection are not indicated at this time. Vitamin E ointment has no proven role in the treatment of DLE.