Joel Bamford MD, Duluth, MN, USA on Oct
Clinically agree with lupus panniculitis. Later developent
of morpheaform features and + ANA would be likely. Without biopsy
demonstration of panniculitis or LE, I think more time is needed.
Clinical trial or treatment with plaquenil is said to produce
response within 2-3 months for Lupus panniculitis.
Amira Adel MD, Egypt on Oct 18, 2005
The most likely diagnosis is DLE. She needs systemic antimalarial
and sunblock + short course of topical medium potency steroid
so as not to increase the atrophy
Khaled El-hoshy MD, Troy, Michigan, USA on
Oct 19, 2005
I would consider Factitious Dermatitis. Atrophie macularis
et varioliformis cutis is another remote possibility. Clinical
picture is suggestive of DLE but pathology is not.
Andrew Carlson MD, Professor,
Divisions of Dermatopathology and Dermatology, Albany Medical
College, Albany, NY, USA on Oct 19, 2005
The upper lip biopsy shows angiofibromatous change in the
superficial dermis pushing down and disrupting elastotic bundles.
There are certainly collagen changes. The nasolabial fold bx
shows a wedged-shaped scar. I don't think lupus or morphea are
in the ddx based on the histology.
Jag Bhawan MD, Professor of Dermatology and Pathology,
Boston University School of Medicine, Boston, Massachusetts,
USA on Oct 20, 2005
It is not morphea histologically.
Rick Sontheimer MD, Professor and Vice-Chairman, Dept.
of Dermatology University of Oklahoma Health Sciences Center,
Oklahama City,OK, USA on October 20, 2005
Perhaps a repeat biopsy from the margin of the newest lesion
with particular attention being paid to possible inflammatory
changes in the subcutaneous tissue.
Haitham Alqari MD, New York, NY, USA on October
Nice case. The feature is clinically suggestive of DLE more
than lupus panniculitis. I will consider using hydroxychloroquine
after checking her vision and G6PD. Add Tacrolimus ointment
and sun block. And repeat skin biopsy in the feature if the
is no improvement.
Jeffrey Callen MD, Professor of Medicine (Dermatology),
Chief, Division of Dermatology, Department of Medicine, University
of Louisville School of Medicine, Louisville, KY, USA
on Oct 21, 2005
The clinical picture looks most like DLE to me, but there is
not an interface dermatitis on the biopsy. I think that the
suggestion of hydroxychloroquine seems reasonable. I will be
interested in hearing about follow up
Khalifa Shaquie MD, PhD, Professor of Dermatology,
College of Medicine, University of Baghdad, Baghdad, Iraq
on Oct 22, 2005
This is an interesting case so called En Coup De Sabre. This
is still incomplete case,that is why the diagnosis is not easy.
This is not infrequently seen in Iraq. The histopathology usaully
shows scar unless taken from fresh active lesion. The management
is by oral steroids and oral zinc sulfate 100mg three times
a day for a long time to stop the progression of the disease.
Thomas Jayakar MD, PhD , Senior Consultant Dermatologist,
Apollo Hospitals and KK Childs Trust Hospital, Chennai, India
on Oct 22, 2005
I would like to draw the attention af all to the following
Janjua SA, McColl I, Thomas J. Lupus panniculitis involvin breast
and parotid/periparotid areas; a rare presentation. J Ayub Med
Shahbaz Janjua MD, Consultant Dermatologist, Ayza
Skin and Research Centre, Lalamusa, Pakistan on Oct
Differential diagnosis for this eruption includes morphea panniculitis,
traumatic panniculitis, and localized lipoatrophy. I would also
suggest a repeat biopsy from the edge of an active/fresh lesion
as the histopath findings are still inconclusive. I would go
for a therapeutic trial of oral antimalarials plus topical steroids
in such cases.
Azad Kassim MD, Hasa, KSA, Saudi Arabia on
Oct 28, 2005
Chronicity of the lesions for years and being on one side of
the face(left side) i.e left upper lip extending to nasolabial
fold with presence of similar lesion on left temple and unremarkable
specific histopathological findings, makes diagnosis of incomplete
linear morphea most likely.
I would suggest avoidance of potent topical steroids to decrease
subsequent skin atrophy. A trial of topical tacrolimus or calcipotriene
may be a reasonable option of treatment with regular follow
Editor's Note on March 21, 2006
This patient had repeat biopsies done and was sent for histological
examination and direct immunofluoresce studies. Unfortunately
both the histology and direct immunofluorescence were negative.
She was started on hydroxychloroquine and awaiting response.