10.5826/dpc.1204a205
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2160-9381
2379
en
Shisheng Chen
https://creativecommons.org/licenses/by-nc/4.0
Dermatology Practical & Conceptual
white rosettes
White rosettes as a new dermoscopic finding in acute cutaneous lupus erythematosus patient with unilateral erythema
Text.Serial.Journal
https://dpcj.org/index.php/dpc
Image Letter
2022-10-31
2022-02-10
2022-10-31
2022-12-05
e2022205
Dermatol Pract Concept
Shisheng Chen
2022/10/31
10.5826/dpc.1204a205
e2022205
Department of Dermatology, The second Affiliated Hospital and Yuying children's hospital of Wenzhou Medical University Wenzhou, Zhejiang, China 
2160-9381
white rosettes
en
e2022205
Ankad BS, Shah SD, Adya KA. White rosettes in discoid lupus erythematosus: a new dermoscopic observation. Dermatology practical & conceptual. 2017;7(4):9-11. DOI:10.5826/dpc.0704a03. PMID:29214102.
White rosettes as a new dermoscopic finding in acute cutaneous lupus erythematosus patient with unilateral erythema
https://dpcj.org/index.php/dpc/article/download/2379/1816
 White Rosettes as a New Dermoscopic Finding in
Acute Cutaneous Lupus Erythematosus Patient With
              Unilateral Erythema
                                              Fangyan Zhou1, Shisheng Chen1


1 Department of Dermatology, The second Affiliated Hospital and Yuying children’s hospital of Wenzhou Medical University Wenzhou,
  Zhejiang, China



Citation: Zhou F, Chen S. White rosettes as a new dermoscopic finding in acute cutaneous lupus erythematosus patient with unilateral
erythema. Dermatol Pract Concept. 2022;12(4):e2022205. DOI: 10.5826/dpc.1204a205
Accepted: March 21, 2022; Published: October 2022
Copyright: ©2022 Zhou 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: Shisheng Chen, M.S., Department of Dermatology, The second Affiliated Hospital and Yuying children’s hospital of
Wenzhou Medical University, No.109 West College Road, Wenzhou, Zhejiang, P.R. China 325027. Email: chshsh168@163.com




Case presentation                                                        Teaching Point
A 65-year-old female presented with a 2-week history of                  Acute cutaneous lupus erythematosus (ACLE) is a sub-
­swelling erythema (10 cm × 8 cm) on her left cheek, with-               category of LE-specific skin disease, which is usually di-
out pruritus, pain, or systemic complaints (Figure 1A).                  agnosed based on typical lesions. Because the ACLE has
Dermoscopy showed some whitish scales, mixed vascular
­                                                                        less cutaneous involvement, it is essential to identify such
pattern, and remarkable white rosettes on a pinkish ­reddish             lesions early for appropriate interventions promptly. White
background (Figure 1B). Skin biopsy of the lesion revealed               rosettes are not lesion-specific and were reported in many
epidermal atrophy in addition to follicular plugging, obvi-              lesions, including discoid lupus erythematosus (DLE) [1],
ously vacuolar degeneration of the basal layer, and remarkable           while there are few reports of white rosettes in ACLE in the
superficial and deep perifollicular lymphocytic inflammatory             literature. In our case, lots of white rosettes with the same
infiltrate (Figure 1C). After treatment of 200 mg hydroxy-               size, shape, and orientation angle are observed in the same
chloroquine daily, the lesion was relieved entirely in the eighth        field of view.
week. We have obtained informed consent from this patient.




Image Letter | Dermatol Pract Concept. 2022;12(4):e2022205                                                                             1
       Figure 1. (A) Unilateral swelling erythematosus patch on the patient’s left face without contralateral involvement. (B) Der-
       matoscopy of a target lesion (the site highlighted in (A)) shows some whitish scales, mixed vascular pattern (black triangle),
       and remarkable white rosettes (black circle) with some white shiny structures (black square) on a pinkish reddish back-
       ground. (C) Histopathological of the skin biopsy showing follicular plug, superficial and deep perifollicular lymphocytic
       infiltrate (H&E×100). (D) Vacuolar degeneration of the basal layer and (E) Remarkable superficial and deep perivascular
       and periadnexal lymphocytic infiltrate at higher magnification from the sites highlighted in (C) respectively (H&E×200).



References
1. Ankad BS, Shah SD, Adya KA. White rosettes in discoid lu-
   pus erythematosus: a new dermoscopic observation. Dermatol
   Pract Concept. 2017;7(4):9-11. DOI:10.5826/dpc.0704a03.
   PMID:29214102. PMCID: PMC5718119.




2                                                                              Image Letter | Dermatol Pract Concept. 2022;12(4):e2022205
