Eyelid discoid lupus erythematosus

Discoid lupus erythematosus (DLE) most commonly affects the face and scalp. Palpebral involvement is rare and not evocative when presenting as the prime manifestation of the disease. We report hereby the case of a young male patient with isolated palpebral and labial DLE. A 34-year-old patient with no medical history was referred from ophthalmology for an erythematous plaque of the eyelid resisting usual treatment of blepharitis. Skin examination revealed a congestive erythema on the right lower eyelid with eyelash fall (Fig. 1). There was also an atrophic cheilitis of the lower lip with slight erosions (Fig. 2). Scalp, oral mucosa and the rest of the integument were not affected. Skin biopsy of the eyelid revealed marked orthokeratosis with slight basal vacuolization and perivascular lymphoplasma cells infiltrate. Direct immunofluorescence displayed a positive lupus band (Fig. 3). Work-up for systemic involvement was negative. Ophthalmologic assessment found no intraocular involvement. Hydroxychloroquine 200mg twice a day with clothing and chemical photoprotection were implemented allowing significant improvement after 3 months (Fig. 4). Palpebral involvement of DLE is uncommon compared to the other suggestive locations including scalp, nose, cheekbones, ears, neckline and hands. An isolated involvement does not suggest DLE at first sight and often leads to delayed diagnosis while scarring and lid deformities might be expected if left untreated [1]. Most commonly it presents as erythematous telangiectasic scaly plaques on the external third of lower eyelid. Blepharitis-like, madarosis, periorbital edema or cellulitis presentations have also been reported [2]. Differential diagnosis may arise with several chronic palpebral dermatoses, as carcinomas, eczema, blepharoconjunctivitis, or seborheic dermatosis. Assessment for intraocular involvement such as keratitis should always be performed [3]. Early recognition and treatment are essential to avoid eyelid complications as ectropion, entropion, and trichiasis. Photoprotection and antimalarials are the mainstay treatment showing remarkable efficacy.