Indian Dermatology Online Journal

: 2019  |  Volume : 10  |  Issue : 3  |  Page : 325--326

An unusual morphological and distribution pattern of chronic cutaneous lupus erythematosus

Manju Meena, Ashok Kumar Khare, Lalit Kumar Gupta, Asit Kumar Mittal 
 Department of Dermatology, Venereology and Leprology, R.N.T. Medical College, Udaipur, Rajasthan, India

Correspondence Address:
Lalit Kumar Gupta
Department of Dermatology, R.N.T. Medical College, Udaipur - 313 001, Rajasthan

How to cite this article:
Meena M, Khare AK, Gupta LK, Mittal AK. An unusual morphological and distribution pattern of chronic cutaneous lupus erythematosus.Indian Dermatol Online J 2019;10:325-326

How to cite this URL:
Meena M, Khare AK, Gupta LK, Mittal AK. An unusual morphological and distribution pattern of chronic cutaneous lupus erythematosus. Indian Dermatol Online J [serial online] 2019 [cited 2020 Jun 4 ];10:325-326
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A 30-year-old male presented with 6 months history of multiple, itchy, well defined, discrete as well as confluent, keratotic plaques with hyperpigmented border over chest and back, distributed in a “Christmas tree pattern” [Figure 1]a. The confluence of lesions on trunk exhibited an interesting “arborising pattern” [Figure 1]b. The lesions were covered with adherent thick scales; carpet tack sign was positive. Face and other sun exposed areas were spared. There was no history of photosensitivity. Mucosae, hair, and nails were normal. Routine hematological and biochemical investigations were normal. Antinuclear antibody (ANA) titers were negative. Histopathological examination showed hyperkeratosis, follicular plugging, and epidermal thinning with basal cell degeneration. Dermis exhibited periappendageal and perivascular lymphocytic infiltrates [Figure 2]a and [Figure 2]b. The patient is improving with topical corticosteroids and oral hydroxychloroquine.{Figure 1}{Figure 2}

Discoid lupus erythematosus (DLE) is the most frequent manifestation of chronic cutaneous lupus erythematosus (CCLE), which in turn is the commonest form of cutaneous lupus erythematosus. It is often divided into 2 subsets: Localized and disseminated. Lesions of localized DLE are limited to head and neck area, while disseminated DLE affects areas below neck also. The lesions start as an erythematosus macule or papule with a scaly surface and then enlarge peripherally into larger discoid plaques that heal with characteristic atrophic scar and pigmentary changes. Apart from DLE, various other known morphological types of CCLE are hypertrophic or verrucous lupus erythematosus,[1] lupus erythematosus profundus,[2] lupus erythematosus tumidus,[3] and chilblain lupus.[4]

Our patient presented with an unusual morphological pattern in which lesions showed an arborising configuration. Another interesting observation was presence of lesions in a Christmas tree pattern on back which is a photo protected region. Christmas tree distribution of skin lesions has been observed in various skin conditions [Table 1].[5] A thorough search of published English literature using the MeSH terms—arborising CCLE/ramiform CCLE/branching CCLE/Christmas tree pattern in Pubmed, Medline, Cochrane library, Google scholar, Scopus and Embase did not reveal such an unusual description of CCLE. This prompted us to report the case.{Table 1}

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The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

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1Kuhn A, Ruzicka T. Classification of cutaneous lupus erythematosus. In: Kuhn A, Lehmann P, Ruzicka T, editors. Cutaneous Lupus Erythematosus. Heidelberg: Springer; 2004. p. 53-8.
2Callen JP. Cutaneous lupus erythematosus: A personal approach to management. Australas J Dermatol 2006;47:13-27.
3Mascaro JM, Herrero C, Hausmann G. Uncommon cutaneous manifestations of lupus erythematosus. Lupus 1997;6:122-31.
4Dutre MS, Beylot C, Beylot J, Pompougnac E, Royer P. Chilblain lupus erythematosus: Report of 15 cases. Dermatology 1992;184:26-8.
5Wollenberg A, Eames T. Skin diseases following a Christmas tree pattern. Clin Dermatol 2011;29:189-94.