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• W2122443668 abstract "Periorbital discoid lupus erythematosus (DLE) is an uncommon skin condition that presents a unique clinical challenge.1Walling H.W. Sontheimer R.D. Cutaneous lupus erythematosus: issues in diagnosis and treatment.Am J Clin Dermatol. 2009; 10: 365-381Crossref PubMed Scopus (62) Google Scholar We report the clinical findings and management in 4 new cases, and present an online review of the relevant literature (Appendix 1 and Table 1, available at http://aaojournal.org) and evidence-based guidelines for its diagnosis and management (Fig 1, available at http://aaojournal.org). A 49-year-old woman presented with 10 years of intermittent erythema and irritation of the left lower eyelid. This had failed to respond to lid hygiene, and topical lubricants and corticosteroids. On examination, she had a central 10×5 mm erythematous plaque reaching the lid margin. A lid biopsy was consistent with DLE and the patient commenced on topical hydrocortisone and oral hydroxychloroquine 200 mg once daily with a considerable improvement in her condition. At 3 months follow up, she is asymptomatic on hydroxychloroquine 200 mg once daily without further recurrence. A 47-year-old woman was referred with 11 years of progressive redness, irritation, and scarring of the left lower eyelid which failed to resolve with lid hygiene, erythromycin ointment, and oral minocycline. Three years later she developed an erythematous annular plaque on the left arm. Biopsies of the eyelid taken 5 years previously and the arm lesion were inconclusive. Examination revealed a 20 mm2 erythematous, scaly plaque with areas of hyperkeratosis, atrophy, and scarring associated with telangiectasia and surrounding erythema, madarosis of the central two thirds of the eyelid, and mild symblepharon (Fig 2A, available at http://aaojournal.org). The other eyelids had mild blepharitis-related changes. Discoid lupus erythematosus was subsequently diagnosed following a second eyelid biopsy. She responded well to 4 weeks of topical corticosteroids and oral chloroquine for 2 years. By 1 year posttreatment, she remains asymptomatic with no recurrence (Fig 2B, available at http://aaojournal.org). A 49-year-old woman presented with 19 months of right lower eyelid itching and a photosensitive red, scaly rash. This had failed to resolve with lid hygiene and topical chloramphenicol and hydrocortisone. Examination revealed a 14×6 mm erythematous, scaly plaque on the lateral half of the pretarsal skin with madarosis, telangiectasia, and mild tarsal conjunctival injection (Fig 2C, available at http://aaojournal.org). Histopathology of an eyelid biopsy was consistent with DLE. Direct immunofluorescence also demonstrated a positive lupus band test. She had a minimal response to 2 intralesional triamcinolone 1-2 mg injections and no response to topical tacrolimus. She was subsequently responded well to 3 months of hydroxychloroquine 200 mg once daily and remains in remission at 1 year posttreatment. A 29-year-old woman presented with a 2-month history of irritation and redness of the right lower eyelid. She had also developed an itchy, scaly, red lesion on her left cheek, and was independently referred to a dermatologist. On examination, there was a 15×5 mm erythematous plaque along the medial aspect of the right lower eyelid margin with associated telangiectasia. There was no scaling or madarosis. She had concurrent medial canthal changes related to angular blepharitis. She also had a 25 mm2 erythematous, scaly plaque at the medial aspect of her left cheek. The patient was initially treated for posterior blepharitis with lid hygiene, oral doxycycline, and betnesol ointment. Following an initial improvement, her lesions became enlarged and more irritable. Review at 2 months demonstrated an erythematous scaly plaque along the entire length of the right lower eyelid margin extending to the medial aspect of the right upper lid (Fig 2D, available at http://aaojournal.org). A full-thickness eyelid biopsy was initially inconclusive. She also developed a new lesion on the left temporal area and a biopsy of this confirmed DLE. On further review, the initial eyelid biopsy was also consistent with DLE (Fig 3, available at http://aaojournal.org). She has responded well to hydroxychloroquine 200 mg twice daily (BD) and by 1 year follow up, remains asymptomatic with no recurrence. Periorbital discoid lupus erythematous remains a significant diagnostic challenge and can require multiple biopsies to diagnose.2Uy H.S. Pineda 2nd, R. Shore J.W. et al.Hypertrophic discoid lupus erythematosus of the conjunctiva.Am J Ophthalmol. 1999; 127: 604-605Abstract Full Text Full Text PDF PubMed Scopus (17) Google Scholar, 3Zedek D.C. Smith Jr, E.T. Hitchcock M.G. et al.Cutaneous lupus erythematosus simulating squamous neoplasia: the clinicopathologic conundrum and histopathologic pitfalls.J Am Acad Dermatol. 2007; 56: 1013-1020Abstract Full Text Full Text PDF PubMed Scopus (16) Google Scholar Oral antimalarials offer a safe and effective treatment.1Walling H.W. Sontheimer R.D. Cutaneous lupus erythematosus: issues in diagnosis and treatment.Am J Clin Dermatol. 2009; 10: 365-381Crossref PubMed Scopus (62) Google Scholar, 4Rothfield N. Sontheimer R.D. Bernstein M. Lupus erythematosus: systemic and cutaneous manifestations.Clin Dermatol. 2006; 24: 348-362Abstract Full Text Full Text PDF PubMed Scopus (53) Google Scholar" @default.
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• W2122443668 date "2012-10-01" @default.
• W2122443668 modified "2023-10-15" @default.
• W2122443668 title "Periorbital Discoid Lupus Erythematosus" @default.
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• W2122443668 doi "https://doi.org/10.1016/j.ophtha.2012.05.041" @default.
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