Case Number : Case 4034 - 07 July 2022 Posted By: Saleem Taibjee

Interface dermatitis with hydropic degeneration of the basal cells and periadnexal lymphocytic infiltrate are suggestive of discoid lupus erythematosus although the subepidermal cleft is a bit unusual

Agree with DLE

Morpphologically diagnostic of DLE. But...in a so weird age?

This was a patient with a historical diagnosis of lupus, recently presenting with these blistering and crusted lesions in the scalp. I too concluded that this must be lupus, and arguably could be designated as a 'bullous' variant which I think is very uncommon (in contrast to the blistering and histological clefting which we not uncommonly see in lichen planus). There is also basement membrane thickening which has not been drawn attention to yet, which is a particularly good clue in this case.

As Vincenzo mentions, the age is unusual. In such a scenario it may also be worthwhile considering a drug-induced aetiology, but as far as I know, this is not thought to be the case here.

BW
Saleem