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| | CASE REPORT | | | | | Year : 1995 | Volume : 61 | Issue : 1 | Page : 36-37 | Verrucous cutaneous lupus erythematosus
Mohan Devinder Thappa, K Venkateswaran Sri, B Reddy
,
Correspondence Address:
Mohan Devinder Thappa
PMID: 20952871 An unusual case of cutaneous lupus erythematous with verrucous lesions is reported for its rarity and clinical interest.
Keywords: Lupus erythematosus, Verrucous
How to cite this article:
Thappa MD, Sri K V, Reddy B. Verrucous cutaneous lupus erythematosus. Indian J Dermatol Venereol Leprol 1995;61:36-7 |
How to cite this URL:
Thappa MD, Sri K V, Reddy B. Verrucous cutaneous lupus erythematosus. Indian J Dermatol Venereol Leprol [serial online] 1995 [cited 2014 Mar 5];61:36-7. Available from: http://www.ijdvl.com/text.asp?1995/61/1/36/4125 |
| Introduction | |  |
The spectrum of lupus erythematosus (LE) extends from the benign chronic cutaneous variety to the often fatal systemic type with nephritis.[1] Apart from the classical discoid lesions of cutaneous LE, less common expressions include verrucous,[2] lichenoid, bullous, LE profundus[3] and LE hypertrophicus et profundus.[4] Herewith, we report a case of LE with verrucous lesions for its rarity, diagnostic dilemma and therapeutic implications.
| Case Report | | |
A 42-year-old man came with asymptomatic verrucous skin lesions over his extremities of 3 years duration. On examination, circumscribed, hyperkeratotic scaly plaques, 5 in number, of size 3-6cm, roughly circular in shape were seen over the forearms [Figure - 1], right knee and left foot. The scales over the plaques were thick, adherent and yellowish brown in colour. Some of the plaques showed atrophy, telangiectasia and depigmentation. The lower lip and buccal mucosa showed erosions with peripheral hyperpigmentation. Systemic examination was unremarkable.
Haemogram revealed anaemia (Hb 8.0gm) with eosinophilia. Renal and liver function tests and skiagram of chest were within normal limits. Serology for syphilis and LE cell phenomenon were negative. Biopsy of the Skin lesion (forearm) showed marked hyperkeratosis, acanthosis, follicular plugging with thinning of epidermis at places and focal dissolution of basal cell layer with melanin incontinence. Upper dermis showed lichenoid [Figure - 2] as well as patchy perivascular lymphohistiocytic infiltrate.
Based on the clinical and laboratory findings, the patient was diagnosed as verrucous cutaneous LE and advised topical corticosteriods. With little response later he was switched over to intralesional corticosteriods with good results.
| Discussion | | |
Probably, the immune response of the host determines the clinical expression of LE and resultant clinical variants of cutaneous LE. Bechet[4] described a variant of chronic cutaneous LE under the name of LE hypertrophicus et profundus, as oval or rounded, sharply outlined, greatly elevated plateau like plaques with rolled borders, at times covered with thick adherent, digitate, verrucous hyperkeratotic scales. This destructive variant of discoid LE produces severe epidermal damage and dermal inflammation extending to the panniculus. LE profundus is another unusual variety of LE in which the cutaneous infiltrate occurs primarily in the deeper portion of the corium with only microscopic epidermal change giving rise to firm, sharply defined nodules lying beneath clinically normal or nearly normal skin.[3]
Clinical and histopathological features in our case were suggestive of verrucous (hypertrophicus) cutaneous LE as there was no involvement of panniculus or deeper corium.
Clinically the hyperkeratotic plaque can be mistaken for keratoachanthoma,[2] lichen planus hypertrophicus (LPH),[5] squamous cell carcinoma and tuberculosis verrucosa cutis.[6] Both LPH and cutaneous LE may cause atrophy or hypertrophy, exhibit photosensitivity and may involve buccal mucosa. Histologically both diseases are characterised by involvment of the basal layer of the epidermis, but moderate acanthosis and hyperkeratosis are seen more commonly ien LP than in LE.[7] Also the presence of severe itching and occurrence over the legs differentiates verrucous LP from discoid LE. Non-itchy hyperkeratotic scaly plaque lesions in our case showed in addition atrophy, depigmentation and microscopic features suggestive of discoid LE.
Topical fluorinated steroids, 5 Fluorouracil or retinoic acid produces little effect in verrucous lesion. Even oral chloroquine has not been found to be usuful. However intralesional steroids have been found to be most effective treatment,[2] including the case reported herein.
| References | | |
| 1. | Prystowsky SD, Herndon JH, Gilliam JN. Chronic cutaneous lupus erythematosus. Medicine 1975;55:183-93.  | | 2. | Uitto J, Santacruz DJ, Esien AZ. Verrucous lesions in patients with DLE. Br J Dermatol 1978;98:507-10. | | 3. | Arnold HL. Lupus erythematosus profundus, Arch Dermatol 1956;73:15-33. | | 4. | Bechet PE, Elizabeth NJ. Lupus erythematous hypertrophicus et profundus. Arch Dermatol 1950;61:495-8. | | 5. | Romero RW, Nesbitt LT. Unusual variant of LE or LP. Arch Dermatol 1977;113:741-4. | | 6. | Callen JP. Therapy of cutaneous lupus erythematous. Med Clin North Am 1982;66:795-807. [PUBMED] | | 7. | Daries MG, Gorkiewicz A, Knight A. Is there a relationship between LP and LE? Br J Dermatol 1977;96:145-9. |
Figures [Figure - 1], [Figure - 2] |
