Clinical features

Initially, CDLE presents with multiple, red, thickened, palpable patches, 1-2 cm in diameter, on the face, neck, scalp or hands. These later form red, well-demarcated plaques with adherent scaling. A mild pruritus and tenderness can be seen as well (1).

New lesions are commonly associated with sun exposure while the older lesions heal with scarring and pigmentary change. The scarred areas are often pigmented on caucasian skin but loss of pigment is more common in coloured skin. On close examination, telangiectasia and follicular plugging may be seen at the erythematous active edge. Unlike SLE, lesions in the scalp may leave a permanent scarring alopecia (1).

Older lesions may present from erythematous plaques to hyperkeratotic, dark gray plaques with centrally depressed scars (1).

Lesions on the hands and feet may resemble chilblains.

Exacerbation may occur:

• in skin trauma
• ultraviolet light exposure
• during pregnancy
• during menstrual or premenstrual periods
• during oral contraceptives use
• associated with certains drugs (procainamide, hydralazine, methyldopa) (1)

Reference:

• 1. Nayla Idriss et al. Dark brown scaly plaques on face and ears. JFP 2006; 55(6)