Erythematous Plaque on the Inferior Eyelid: JAMA
A 40-year-old healthy woman presented with an 8-year history of a slowly growing erythematous plaque on the left lower eyelid, with occasional discomfort. Physical examination revealed a single erythematous scaling plaque involving the left lower eyelid, including its border. Eyelashes were totally absent (Figure 1A).

No other lesions were found after complete physical examination. Dermoscopy showed an erythematous background, telangiectatic vessels, whitish structureless areas, and whitish scales (Figure 1B). A 4-mm punch biopsy specimen was obtained (Figure 1C).

Patient was diagnosed with Discoid Lupus Erythematosus.

Histopathologic examination demonstrated an atrophic epidermis with parakeratosis, vacuolar alteration of the basal layer, and dense inflammatory infiltrate both in papillary and reticulate dermis, consistent with discoid lupus erythematosus (DLE) (Figure 1C). Antinuclear antibodies and double-stranded DNA serologic testing were negative.

The patient was treated with high-potency topical corticosteroid for 10 days, followed by tacrolimus, combined with oral hydroxychloroquine 400 mg daily. At the 2-month follow-up visit, lesions had completely resolved (Figure 2).

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