Discoid lupus erythematosus in the conchal bowl

A 44-year Fitzpatrick II female (Figure 1a) and 37-year Fitzpatrick V male (Figure 1b) presented to our Dermatology Clinic with annular plaques with central scarring and follicular plugging on the face, pinna, and conchal bowls. Both cases had serology strongly positive for ANA and double-stranded DNA, supportive of a diagnosis of discoid lupus erythematosus (DLE). Hydroxychloroquine was initiated for both patients due to minimal response to topical steroids. Patient B had an additional diagnosis of systemic lupus erythematosus based on concurrent lupus nephritis and autoimmune haemolytic anaemia, and further consideration will be given to mycophenolate mofetil and belimumab. Auricular involvement is common in DLE, and conchal bowl involvement has been included in DLE classification criteria1 with potentially higher frequency in Black patients.2 Lesions are difficult to biopsy in this anatomic area; however, dermoscopy can be a useful adjunct to identify features, including perifollicular white halos, dyspigmentation, follicular plugging (white dots), telangiectasias and atrophic scarring.3-5 Treatment is necessary to reduce disfigurement and includes topical corticosteroids, nonsteroidal agents and retinoids, as well as traditional systemics including methotrexate and hydroxychloroquine. Although biologics are not currently widely approved for cutaneous lupus, the horizon involves belimumab, a B-lymphocyte stimulator monoclonal antibody, and anifrolumab, an interferon-1 monoclonal antibody. As lupus erythematosus can manifest in numerous organs and present to multiple specialities, it is important for all physicians to recognize the auricular involvement of discoid lupus. This can be seen in a wide range of skin types and can serve as an early diagnostic feature of this condition. Airiss R. Chan: Idea generation; patient consent; writing; revisions. Elaine Yacyshyn: Idea generation; writing; revisions. Eunice Chow: Patient consent; writing; revisions. The authors declare no conflict of interest. All patients in this manuscript have given written informed consent for participation in the study and the use of their deidentified, anonymized, aggregated data and their case details (including photographs) for publication. Ethical Approval: not applicable. Data sharing is not applicable to this article as no new data were created or analysed in this study.