Eyelid Discoid Lupus Erythematosus Presenting with Chronic Blepharoconjunctivitis, Mimicking Mucous Membrane Pemphigoid

Abstract

Discoid lupus erythematosus (DLE) is the most common form of chronic cutaneous lupus erythematosus. DLE can occur on sun-exposed areas and mucosal surfaces. However, DLE on the ocular mucosa, presenting as chronic blepharoconjunctivitis, is rare and may lead to misdiagnosis with other skin conditions, especially autoimmune diseases like mucous membrane pemphigoid. Moreover, due to the rarity of DLE on the eye, the delay in diagnosis may result in complications and morbidity on the effected eyes. Dermoscopy is a non-invasive tool, commonly used to aid the diagnosis of many skin conditions. Dermoscopic findings in DLE are well-established. However, in this case we used dermoscopy to examine DLE lesions on the ocular and eyelid skin surface which is rarely reported in the literature. Our dermoscopic evaluation showed telangiectasia, non-atrophic round erythema, brownish pigmentation with adherent scales on skin surface and non-atrophic round erythema with adherent scales on mucosal surface. Antimalarial drugs are the first-line systemic therapy and also most commonly used in the literatures for eyelids DLE. In this case, we also reported that dapsone in addition to hydroxychloroquine were effective treatments for eyelid DLE. Moreover, multidisciplinary care with ophthalmologist is essential to maximize treatment outcome and prevent further complications.