The patient is an otherwise healthy 30 yo man in good general health. For two months he has had a slightly pruritic dermatitis on his forehead.
Clinically, we considered En Coup de Sabre (Linear scleroderma)
Dermatoscopic Image: (Courtesy of Makayla Powers PA-C)
Punch biopsy showed:
Lichenoid interface and perifollicular dermatitis with postinflammatory pigment alteration. No features of localized scleroderma. These findings are suggestive of discoid L.E. or linear L.P.
Photomics courtesy of David Jones, MD, Berkshire Medical Center, Pittsfield, Massachusetts.
Treatment was initiated with clobetasol ointment. Will switch to tacrolimus ointment if response is good.
References
1.
Rodriguez E et. Al. Acute Onset Linear Lichen Planus Pigmentosus of the
Forehead: A Case Series J Drugs Ddermatol 2023 Jan 1;22(1):94-97. Free Full Text
2. Khelifa E. Linear sclerodermic lupus erythematosus, a distinct variant of linear morphea and chronic cutaneous lupus erythematous. Int J Dermatol 2011 Dec;50(12):1491-5. PMID 22097995
3. Reference suggested by Dr. Sontheimer. Dao DP, Sahni DR, Sontheimer DR. Linear discoid lupus erythematous simulating en coup de sabre morphea in a female chronic granulomatous disease carrier. Dermal Online J. 2023 Dec 15;29(6). Free Full Text.
4. Das A et al. Linear lesions in dermatology: a clinicoaetiopathological study. Clin Exp Dermatol 2021 Dec;46(8):1452-1461. PMID: 34022084
5. Urur YG. Et. Al. Dermoscopic Characteristics of Cutaneous Lupus Erythematosus According to Subtype, Lesion Location, Lesion Duration, and CLASI Score. Dermatol Pract Concep. 2024 Jan 1;14(1):e2024040. Free Full Text.
Comment from Rick Sontheimer: a very similar case of “Blashkonian” linear discoid LE several years ago in the Dermatology Online Journal: https://escholarship.org/uc/item/88z197dr
ReplyDelete(I'll add reference to above -- DJE)
More from Rick Sontheimer:
ReplyDeleteThe text describing the punch biopsy results in the VGRD webpage description of this case read:
“Lichenoid interface and perifollicular dermatitis with post-inflammatory pigment alteration. No features of localized scleroderma. These findings are suggestive of discoid L.E. or linear L.P.”
Those histopathologic findings in my view are very typical of discoid LE.
And, to you question about checking for evidence of underlying systemic LE, yes I would recommend a screening antinuclear antibody assay. If that is negative, I would not go any further. In the literature concerning this linear clinical pattern of DLE expression, there has been only a weak association with systemic LE.
Need more history. Looks like post HSV outbreak recurrent. What is the history?
ReplyDeleteDoug J
Hi Doug, 3 month history. Path does not show findings of HSV; but it is a good thought. Thanks.
DeleteFrom Heather Zimmerman, JABSOM: I saw the treatment for either linear LP or LE is similar, besides avoiding sunlight for lupus. Is there any way to distinguish, or not necessary if it responds to clobetasol? Very interesting case!
ReplyDeleteFrom Patrick Kenny, Victoria, BC: Thanks for the dermoscopy image which shows follicular plugged structures which are features of cutaneous lupus erythematosus . These are part of the FEAST findings in lupus
ReplyDelete