10.5826/dpc.1301a48
text/xml
2160-9381
2527
en
Elif Cansel Ozcakir
https://creativecommons.org/licenses/by-nc/4.0
Dermatology Practical & Conceptual
Cutaneous Lupus Erythematosus Mimicking Acne Vulgaris
Text.Serial.Journal
https://dpcj.org/index.php/dpc
Image Letter
2023-01-31
2022-04-09
2023-01-31
2023-03-01
e2023048
Dermatol Pract Concept
Elif Cansel Ozcakir
2023/01/31
10.5826/dpc.1301a48
e2023048
Istanbul University-Cerrahpasa, Cerrahpasa medical Faculty, Department of Dermatology, Istanbul, Turkey
2160-9381
en
e2023048
Henostroza-Inga K, Torres-Ibérico R, Atamari-Anahui N, Lipa-Chancolla R. Dermatitis granulomatosa neutrofílica en empalizada como presentación inicial de lupus eritematoso sistémico [Palisaded neutrophilic granulomatous dermatitis as the initial presentation of systemic lupus erythematosus]. Bol Med Hosp Infant Mex. 2021;78(6):652-656. DOI: 10.24875/BMHIM.21000035. PMID: 34934217.
Cutaneous Lupus Erythematosus Mimicking Acne Vulgaris
https://dpcj.org/index.php/dpc/article/download/2527/1915
                          Cutaneous Lupus Erythematosus
                              Mimicking Acne Vulgaris
                                 Tugba Kevser Uzuncakmak1, Elif Cansel Özcakir2


1 Sisli Memorial Hospital, Department of Dermatology, Istanbul, Turkey
2 Istanbul University-Cerrahpasa, Cerrahpasa medical Faculty, Department of Dermatology, Istanbul, Turkey



Citation: Uzuncakmak TK, Özcakir EC. Cutaneous Lupus Erythematosus Mimicking Acne Vulgaris. Dermatol Pract Concept.
2023;13(1):e2023048. DOI: https://doi.org/10.5826/dpc.1301a48
Accepted: August 26, 2022; Published: January 2023
Copyright: ©2023 Uzuncakmak 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: Tugba Kevser Uzuncakmak, MD, Sisli Memorial Hospital, Department of Dermatology, Istanbul, Turkey.
Telephone: 0 +90- (530) 6640226 E-mail: drtugbakevserustunbas@gmail.com




Case Presentation                                                        were negative. Serum complement C3 and C4 levels were
                                                                         within normal limits. Based on the clinical, histopathologi-
A 19-year-old female presented with cicatricial acneiform le-            cal and laboratory findings, a diagnosis of cutaneous lupus
sions bilaterally on cheeks and subcutaneous nodular lesions             erythematosus was made. The patient was referred to the
on the bilaterally proximal aspect of the upper and lower                Rheumatology department and treated with a daily regimen
extremities (Figure 1, A-E). She was previously diagnosed                of azathioprine 100 mg, hydroxychloroquine 400 mg, pred-
with acne vulgaris and treated with topical 2% erythromy-                nisolone 5 mg and indomethacin 25 mg. Topical tacrolimus
cin and isotretinoin 0.05 % gel for one year. Dermoscopic                0.03% ointment and tretinoin 0.025 % cream were also
examination of the facial lesions revealed multiple linear and           administered for the treatment of the cutaneous lesions on
branching vessels over translucent yellowish-orange globular             her face.
structures on scar-like areas (Figure 1, A and B). An inci-
sional biopsy was performed from the atrophic plaque on the
                                                                         Teaching Point
right arm. The histologic specimen shown lobular panniculi-
tis accompanied by core crumbs, focal fibrin thrombi, focal              Lupus erythematosus is one of the major imitators in der-
hyaline necrosis, and lipomembranous changes (Figure 1G).                matology and may present with various cutaneous manifes-
An additional punch biopsy from the facial lesion reported               tations such as symmetrical confluent erythema and edema
a granuloma formation, perivascular and perifollicular in-               overlying the malar cheeks, erythema and edema of the hands,
flammation accompanied by calcification (Figure 1H). Lab-                symmetric erythematous eruption of non-indurated mac-
oratory tests revealed positivity for double stranded DNA                ules and papules, scaly annular lesions or papulo-squamous
and antinuclear antibodies (ANA) homogeneously positive                  plaques, exfoliative erythroderma, discoid scaly purplish mac-
with a titer of 1:320. Anti-SS-A, anti-SS-B and anti-CCP                 ule or papules, hyperkeratotic/verrucous, bullous, urticarial or




Image Letter | Dermatol Pract Concept. 2023;13(1):e2023048                                                                             1
Figure 1. (A,B) Multiple bizarre cicatricial acneiform lesions on cheeks with multiple linear and branching vessels over translucent
yellowish-orange globular structure on scar-like areas, dermoscopically. (C) Multiple subcutaneous atrophic nodular lesions on the right
arm. (D) Subcutaneous atrophic nodular lesion on the left arm. (E) Multiple subcutaneous nodular lesions on the lower proximal extremity.
(F) Septal thickening and lobular inflammation rich in histiocytes (H&E, x200). (G,H) Periadnexial inflammation with focal granulomatous
reaction (H&E, x40, x200).




mucosal lesions [1]. To date, acneiform presentation and gran-            2019;8(1):276-279. DOI: 10.4103/jfmpc.jfmpc_376_18. PMID:
ulomatous formation as seen in our patient have been rarely               30911520. PMCID: PMC6396584.
                                                                       4. Deruelle-Khazaal R, Ségard M, Cottencin-Charrière AC,
reported both in cutaneous and systemic lupus erythema-
                                                                          Carotte-Lefebvre I, Thomas P. Lésions acnéiformes révélatrices
tous [2-7] Hence, lupus erythematous should be definitely in-
                                                                          d’un lupus érythémateux chronique [Chronic lupus erythema-
cluded in the differential diagnosis of refractory acne lesions,          tosus presenting as acneiform lesions]. Ann Dermatol Venereol.
and in these cases dermoscopy should be considered manda-                 2002;129(6-7):883-885. PMID: 12218916.
tory for the diagnosis of difficult-to-treat acneiform eruptions.      5. Vieira ML, Marques ERMC, Leda YLA, Noriega LF, Bet DL,
                                                                          Pereira GAAM. Chronic cutaneous lupus erythematosus pre-
                                                                          senting as atypical acneiform and comedonal plaque: case re-
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