Clinical and dermoscopic spectrum of discoid lupus erythematosus: novel observations from lips and oral mucosa.

BACKGROUND: Under dermoscopy, discoid lupus erythematosus (DLE) exhibits specific findings. Commonly DLE lesions affect sun-exposed sites, especially the face. However, most of the dermoscopic reports come from scalp DLE. To our knowledge, the dermoscopic pattern for mucosal and labial DLE has not been previously reported.

METHODS: This study included 20 patients with histopathologically confirmed DLE lesions. Full history taking was obtained with photo documentation of lesions including the sites involved, the number of lesions per site, and the total number of lesions affecting every patient. Finally, a dermoscopic examination was performed.

RESULTS: Almost 85% of patients had only cutaneous DLE lesions, while 15% showed both cutaneous and mucosal lesions. Follicular keratotic plugging (56.1%) and scales (52.6%) were the most frequently detected dermoscopic criteria. A significant correlation was found between lesion's age and the following dermoscopic criteria: (early lesions: follicular keratotic plugs and perifollicular white halos; while late lesions: telangiectasia and white structureless areas). Furthermore, telangiectasia, white structureless areas, and ulceration were found in dermoscopy of mucosal DLE. Also, telangiectasia, brown pigment spots, scales, white structureless areas, bleeding spots, and erosions were detected in dermoscopy of labial DLE. Moreover, labial storiform telangiectasia was seen under dermoscopy in patients with associated SLE.

CONCLUSIONS: Dermoscopy is a valuable tool for diagnosing DLE at different sites and in differentiating between the early and end-stage lesions. Herein, we reported the first dermoscopic view for DLE affecting the lips and oral mucosa. Labial storiform telangiectasia could be a dermoscopic sign of coexisting SLE.