Decoding discoid lupus erythematosus: A microscopic and dermoscopic perspective

Background: Classic discoid lupus erythematosus (DLE) is the most common type of chronic cutaneous lupus erythematosus (LE). Several studies have shown the usefulness of dermoscopy in diagnosis and in assessing the duration of the disease. Aims and Objectives: To study the dermoscopic features of scalp and non-scalp DLE. Materials and Methods: Cross-sectional observational study on 72 consecutive patients with classic DLE attending the dermatology department of Government Medical College, Kottayam, with biopsy and dermoscopy in all. Results: The mean age was 47.67±11.39 years. M: F ratio was 0.44:1. The duration was <1 year in only 11.1%. Histologically, epidermal atrophy and basement membrane thickening showed statistical association with disease duration >1 year, and dermal mucin deposition with duration <1 year. Dermoscopy showed a significant association of perifollicular whitish halo with non-scalp lesions and follicular red dots and white structureless areas with scalp lesions. In the non-scalp lesions, follicular keratotic plugging, perifollicular whitish halo, white scales, and whitish structureless areas were statistically associated with disease duration >1 year, and follicular red dots and short linear vessels with duration <1year. In scalp DLE, the presence of whitish structureless areas, perifollicular white halo, and blue-gray dots, and the absence of follicular opening were statistically more common in lesions with duration >1 year. Conclusion: The varied dermoscopic features of classic DLE of both scalp and non-scalp areas not only help in the diagnosis but also in understanding the duration of the disease. However, further studies with a larger sample size are needed to find out the sensitivity and specificity of each finding to standardize the diagnostic utility of each.