Discoid lupus erythematosus: when a superficial injury is a red herring of underlying disease

Description

A 64-year-old woman with no dermatological history presents with a rash over her left eyebrow for the past 3 months with associated itching. The patient also states she has a bruise on her scalp from an accidental injury 1 year previously that continues to be sore. She was previously seen by her primary care physician after her injury, who dismissed the lesion as a haematoma.

On physical examination, the patient has a single erythematous papule on the left eyebrow with grey dot granules and mild telangiectasia (figure 1). On examination of the right frontal scalp, the patient has a well-demarcated, erythematous lesion with induration and overlaying alopecia (figure 2). Remaining dermatological examination is unremarkable.

Figure 1

Image of left eyebrow; note lesion encircled by blue ink.

Figure 2

Right frontal scalp; note multiple lesions encircled by blue ink...

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