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In this section we have spot diagnoses posted on a daily basis since June 2010, now over 1700! You can review the archived cases and read the suggested diagnoses by users and the final comment by Dr Uma Sundram, the Editor-in-Chief and main spot diagnosis host. Case are uploaded each week day by 10 a.m. UK time with the correct diagnosis will generally be posted at 8 p.m. UK time. Why not view the most recent spot diagnosis and proffer a diagnosis?

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

Please read the clinical history and view the images by clicking on them before you proffer your diagnosis.
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81F punch biopsy left parietal scalp. Scaly erythematous patches in the scalp


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Anil Patki

Posted

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

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Meenakshi Batrani

Posted

Agree with DLE

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vincenzo

Posted

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

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Saleem Taibjee

Posted

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

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