10.5826/dpc.1303a188
text/xml
2160-9381
3029
en
Mohamed Denguezli
https://creativecommons.org/licenses/by-nc/4.0
Dermatology Practical & Conceptual
Comedonal Plaque on the Face
Text.Serial.Journal
https://dpcj.org/index.php/dpc
Image Letter
2023-07-31
2022-11-26
2023-07-31
2023-08-24
e2023188
Dermatol Pract Concept
Mohamed Denguezli
2023/07/31
10.5826/dpc.1303a188
e2023188
Dermatology Department, Faculty of Medicine of Sousse, Farhat Hached University Hospital, Sousse, Tunisia
2160-9381
en
e2023188
Hammami, F. et al. Le lupus comédonien : particularités cliniques et dermoscopiques. Annales de Dermatologie et de Vénéréologie 146, A217 (2019).
Comedonal Plaque on the Face
https://dpcj.org/index.php/dpc/article/download/3029/2248
                             Comedonal Plaque on the Face
       Haifa Mkhinini1, Nadia Fetoui Ghariani1, Badreddine Sriha2, Mohamed Denguezli1


1 Dermatology Department, Faculty of Medicine of Sousse, Farhat Hached University Hospital, Sousse, Tunisia
2 Anatomopathology Department, Faculty of Medicine of Sousse, Farhat Hached University Hospital, Sousse, Tunisia



Citation: Mkhinini H, Fetoui ghariani N, Sriha B, Denguezli M. Comedonal Plaque on the Face. Dermatol Pract Concept.
2023;13(3):e2023188. DOI: https://doi.org/10.5826/dpc.1303a188
Accepted: March 6, 2023; Published: July 2023
Copyright: ©2023 Mkhinini et al. This is an open-access article distributed under the terms of the Creative Commons Attribution-
NonCommercial License (BY-NC-4.0), https://creativecommons.org/licenses/by-nc/4.0/, which permits unrestricted noncommercial use,
distribution, and reproduction in any medium, provided the original authors and source are credited.
Funding: None.
Competing interests: None.
Authorship: All authors have contributed significantly to this publication.
Corresponding author: Haifa Mkhinini, Resident, Faculty of Medicine of Sousse Dermatology Department, Farhat Hached University
Hospital, Sousse, Tunisia. E-mail: Haifa.mkhinini90@gmail.com




Case Presentation                                                        positive (1:80), while systemic assessment results were neg-
                                                                         ative. Hydroxychloroquine and sunscreen were prescribed.
A 48-year-old woman, with no medical history, presented
with a unilateral asymptomatic facial lesion that had been
evolving for 3 years. Dermatological examination revealed a
                                                                         Teaching Point
linear erythematous plaque with open comedones on the sur-
face, located on the right infraorbital region (Figure 1A). The          CL is a rare variant of chronic cutaneous erythematous lupus
rest of the physical examination was unremarkable. Der-                  with a risk of systemic progression [1]. It usually appears as
moscopy revealed brownish keratotic plugs, milia-like cysts              an erythematous pruritic comedonal plaque, on seborrheic
and telangiectatic vessels on an erythematous background                 regions, at the age of 25 to 35 years1,2. Although histopatho-
(Figure 1B). Histopathological examination of a skin biopsy              logical assessment is mandatory, dermoscopic examination
showed keratotic plugs and comedones, epidermal atrophy,                 can be useful to refine the diagnostic approach. Differential
vacuolar degeneration of the basal layer and dense perivas-              diagnoses include nevus comedonicus, Favre-Racouchot
cular and periadnexal lymphocytic infiltrate (Figure 1C).                syndrome, lichen follicularis and acne vulgaris. Treatment
Direct immunofluorescence revealed the presence of IgM,                  is mainly based on photoprotection and oral hydroxychlo-
IgG, IgA and C3 deposits at the dermal-epidermal junction                roquine. Other treatments can be used such as minocy-
(Figure 1D). These findings were consistent with the diag-               cline, oral or topical retinoids and intralesional or topical
nosis of comedonic lupus (CL). Antinuclear antibodies were               corticosteroids1.




Image Letter | Dermatol Pract Concept. 2023;13(3):e2023188                                                                           1
Figure 1. (A) Infraorbital erythematous plaque with open comedones on the surface. (B) Dermoscopic image (Dermlite DL4, polarized
mode) showing brownish keratotic plugs (black arrow) and milia-like cysts (black circle) on an erythematous background (white star).
(C) Histological examination showing keratotic plugs and comedones (black stars), vacuolar degeneration of the basal cell layer (yellow
arrow), periadnexal inflammatory infiltrate (green star) (H&E, x40). (D) Positive lupus band test on direct immunofluorescence.




References                                                            2. F. Hammami F, E. Bahloul E, A. Masmoudi A, et al. Le lupus
                                                                         comédonien : particularités cliniques et dermoscopiques. Annales
1. Chessé C, Fernández-Tapia MJ, Borzotta F. Comedonic Lupus:            de Dermatologie et de Vénéréologie. 2019;146(12):A217. DOI:
    An Unusual Presentation of Cutaneous Lupus. Actas Der-               10.1016/j.annder.2019.09.327.
    mosifiliogr (Engl Ed). 2021;112(4):370-371. DOI: 10.1016/j
    .ad.2019.07.013. E PMID: 33130011.




2                                                                           Image Letter | Dermatol Pract Concept. 2023;13(3):e2023188
