CASE #1: Erythematous Plaques With Scaling

[...]cutaneous lupus is 2to 3-times more common than systemic lupus erythematosus (SLE) and thus often occurs independently.3 DLE most commonly presents in African American women as well-demarcated, coin-shaped lesions with central clearing that are susceptible to scarring alopecia.1,3 These lesions are diagnosed clinically, although histology and lupus band testing can be useful diagnostic tools.3 Treatment involves sun protection, smoking cessation, and medical therapy such as topical corticosteroids, topical calcineurin inhibitors, and systemic antimalarial therapy.1'3'4 DLE falls within the broad category of lupus erythematosus and more specifically cutaneous lupus. [...]smoking has been shown to induce T-cell proliferation.1 In accordance with these immunologic factors, IFN types I (a and ß) and II (7) have been associated with the development of DLE.5 Increased production of type I IFNs by plasmacytoid dendritic cells has been found to contribute to the accumulation of autoimmune debris that causes DLE via increased production of apoptotic factors, such as TNF-related apoptosis-inducing ligand (TRAIL).5,6 INF-7 induces differentiation of naive T-cells to Th1 cells; in DLE specifically, cutaneous inflammatory infiltrates are predominately Th1 mediated.1,4-6 Clinically, DLE presents as well-demarcated, round, erythematous plaques that slowly become indurated with associated adherent follicular hyperkeratosis.1-3,7 Removal of this scale is painful and reveals keratotic spikes commonly known as the carpet tack sign.1-3 Peripheral expansion leaves an atrophic, hypopigmented central depression with telangiectasias.1,4 Active lesions eventually resolve; however, patients may experience persistent scarring alopecia as lesions tend to extend into the hair follicle.3 On rare occasions squamous cell carcinoma arises from old lesions.1,3,4 Aside from rash, arthralgia is the most common systemic complaint in patients with DLE .8 Of note, patients of any age can be affected by DLE; however, it most commonly affects middle-aged women.1,3 The distribution of lesions can further classify DLE into localized and disseminated variants. DLE occurs predominantly above the neck on the face, scalp, and ears.1,4 Localized DLE is limited to this distribution above the neck, while disseminated DLE presents with lesions below the neck as well.1 Only 20% of patients develop disseminated DLE, but this variant is associated with higher rates of SLE.1,2 Lesions on the trunk or extr