Dermatology: Practical and Conceptual


Image Letter | Dermatol Pract Concept. 2022;12(4):e2022205 1

White Rosettes as a New Dermoscopic Finding in 
Acute Cutaneous Lupus Erythematosus Patient With 

Unilateral Erythema
Fangyan Zhou1, Shisheng Chen1

1  Department of Dermatology, The second Affiliated Hospital and Yuying children’s hospital of Wenzhou Medical University Wenzhou, 

Zhejiang, China

Citation: Zhou F, Chen S. White rosettes as a new dermoscopic finding in acute cutaneous lupus erythematosus patient with unilateral 
erythema. Dermatol Pract Concept. 2022;12(4):e2022205. DOI: 10.5826/dpc.1204a205

Accepted: March 21, 2022; Published: October 2022

Copyright: ©2022 Zhou et al. This is an open-access article distributed under the terms of the Creative Commons Attribution-
NonCommercial License (BY-NC-4.0), https://creativecommons.org/licenses/by-nc/4.0/, which permits unrestricted noncommercial use, 
distribution, and reproduction in any medium, provided the original authors and source are credited.

Funding: None.

Competing interests: None.

Authorship: All authors have contributed significantly to this publication.

Corresponding author: Shisheng Chen, M.S., Department of Dermatology, The second Affiliated Hospital and Yuying children’s hospital of 
Wenzhou Medical University, No.109 West College Road, Wenzhou, Zhejiang, P.R. China 325027. Email: chshsh168@163.com

Case presentation

A 65-year-old female presented with a 2-week history of 

 swelling erythema (10 cm × 8 cm) on her left cheek, with-

out pruritus, pain, or systemic complaints (Figure 1A). 

 Dermoscopy showed some whitish scales, mixed vascular 

pattern, and remarkable white rosettes on a pinkish  reddish 

background (Figure 1B). Skin biopsy of the lesion revealed 

epidermal atrophy in addition to follicular plugging, obvi-

ously vacuolar degeneration of the basal layer, and remarkable 

superficial and deep perifollicular lymphocytic inflammatory 

infiltrate (Figure 1C). After treatment of 200  mg hydroxy-

chloroquine daily, the lesion was relieved entirely in the eighth 

week. We have obtained informed consent from this patient.

Teaching Point

Acute cutaneous lupus erythematosus (ACLE) is a sub-

category of LE-specific skin disease, which is usually di-

agnosed based on typical lesions. Because the ACLE has 

less cutaneous involvement, it is essential to identify such 

lesions early for appropriate interventions promptly. White 

rosettes are not lesion-specific and were reported in many 

lesions, including discoid lupus erythematosus (DLE) [1], 

while there are few reports of white rosettes in ACLE in the 

literature. In our case, lots of white rosettes with the same 

size, shape, and orientation angle are observed in the same 

field of view.



2 Image Letter | Dermatol Pract Concept. 2022;12(4):e2022205

Figure 1. (A) Unilateral swelling erythematosus patch on the patient’s left face without contralateral involvement. (B) Der-

matoscopy of a target lesion (the site highlighted in (A)) shows some whitish scales, mixed vascular pattern (black triangle), 

and remarkable white rosettes (black circle) with some white shiny structures (black square) on a pinkish reddish back-

ground. (C) Histopathological of the skin biopsy showing follicular plug, superficial and deep perifollicular lymphocytic 

infiltrate (H&E×100). (D) Vacuolar degeneration of the basal layer and (E) Remarkable superficial and deep perivascular 

and periadnexal lymphocytic infiltrate at higher magnification from the sites highlighted in (C) respectively (H&E×200).

References

1. Ankad BS, Shah SD, Adya KA. White rosettes in discoid lu-

pus erythematosus: a new dermoscopic observation. Dermatol 

Pract Concept. 2017;7(4):9-11. DOI:10.5826/dpc.0704a03. 

PMID:29214102. PMCID: PMC5718119.