Bullous systemic lupus erythematosus (BSLE) is a rare cutaneous . Lúpus eritematoso sistêmico bolhoso – diagnóstico diferencial com dermatite herpetiforme. O lúpus eritematoso sistêmico pode apresentar inúmeras lesões cutâneas. As lesões bolhosas específi cas do lúpus, apesar de raras, apresentam. Systemic lupus erythematosus (SLE) can cause numerous skin lesions. Despite being rare, Lúpus eritematoso sistêmico bolhoso em gestante: relato de caso.

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Chronic cutaneous lupus erythematosus is a polymorphous autoimmune disease which may mimic some other clinical conditions, causing diagnostic difficulties. Acneiform lesions, including comedones bolohso pitting scars are occasionally atypical presentations of cutaneous discoid lupus erythematosus.

Chronic cutaneous discoid lupus erythematosus CCDLE or discoid lupus eryhthematosus DLE is a rare chronic auto-immune luups and the most common clinical variant of the lupus erythematosus LE. It is caused or triggered by exposure to ultraviolet radiation, cold and drugs and develops gradually. The diagnosis of DLE is confirmed by histopathological examination.

Uncommon clinical manifestations, like comedonic lupus can mimic other diseases like acne vulgaris, Favre-Racouchot disease, milium, milia en plaquesyringoma, tricoepithelioma, clustered dilated pores and nevus comedogenic. The dermatologic lupue showed lightly-colored violaceous, infiltrated plaques of various sizes and atrophic scars on the right ear, dorsal aspect of the nose and chin.

Comedonic lupus: a rare presentation of discoid lupus erythematosus

Comedones and pitting scars were noted on a partially infiltrated plaque on the chin Figure 1. The histopathological examination showed acanthosis, vacuolar degeneration of the basal cell layer, pigmentary incontinence, periadnexial mononuclear infiltrate, follicular plugging and comedones.


PAS staining evidenced thickening of the basal membrane BM of the epidermis, more intense around the hair follicles Figure 2.

Treatment started with sunscreen applied to the skin and systemic use of mg of tetracycline twice a day for three weeks and then mg twice a day for another thirty days. There was improvement of the pruritus and the number of comedones Figure 3.

Bullous systemic lupus erythematosus in a year-old child

With discontinuation of the tetracycline there was an acute recurrence of the lesions. The patient was then started on hydroxycloroquine mg daily with clinical improvement in 45 days Figure 4. After six months of use of hydroxycloroquine there was marked improvement Figure 5. During twelve months of follow-up no signs or symptoms of systemic disease were bolhosso. The clinical manifestations of CCLE are multiple and varied. The acneiform presentation of discoid CCLE is rare and only six cases have been reported so far.

The cause of the comedogenic form of the CLE is not yet clear and bolhodo prognosis is uncertain. It is supposed that at least half of the patients with this condition have the tendency to develop systemic LE.

The differential diagnosis of comedogenic discoid CLE are: Favre-Racouchot disease, also known as ‘cutaneous nodular elastoidosis with cysts and comedones’ is characterized by volumous open, black comedones, located on the sun damaged skin of the elderly.

The diagnosis of comedonic DLE was confirmed mainly by the histopathological changes. The histological findings are comparable to those on the literature review, like: Tetracycline was suggested at the beginning of the treatment and an antinflammatory and immunoregulator agent that has been successful on the treatment of acneiform conditions.


The present case reinforces the importance of taking into consideration the various forms of presentation and the atypical behavior of discoid CLE, like the presence of acneiform lesions, accompanied by suggestive signs of CLE, that do not respond to conventional treatment to acne vulgaris. A case of discoid lupus erythematosus masquerading as acne.

Al-Refu K, Goodfield M. Scar classification in cutaneous lupus erythematosus: Discoid lupus erythematosus presenting with cysts, comedones, and cicatricial alopecia on the scalp. J Am Acad Dermatol ; Discoid lupus erythematosus presenting as acneiform pitting scars.

Chronic lupus erythematosus presenting as acneiform lesions. Systemic lupus erythemato sus in patients diagnosed with treatment-resistant acne. Int J Dermatol ; Int Soc Dermatol ; J Pak Med Assoc. Trichoepithelioma of the vulva: J Low Genit Tract Dis.

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Histopatologia da pele de Lever. Sapadin AN, Fleischmajer R. J Am Acad Dermatol. Approved by the Advisory Board and accepted for publication on All the contents of this journal, except where otherwise noted, bolnoso licensed under a Creative Commons Attribution License. Services on Demand Journal. Rio Branco, 39 How to cite this article.