Dermatology: Practical and Conceptual


Image Letter | Dermatol Pract Concept. 2023;13(3):e2023188 1

Comedonal Plaque on the Face
Haifa Mkhinini1, Nadia Fetoui Ghariani1, Badreddine Sriha2, Mohamed Denguezli1

1 Dermatology Department, Faculty of Medicine of Sousse, Farhat Hached University Hospital, Sousse, Tunisia

2 Anatomopathology Department, Faculty of Medicine of Sousse, Farhat Hached University Hospital, Sousse, Tunisia

Citation: Mkhinini H, Fetoui ghariani N, Sriha B, Denguezli M. Comedonal Plaque on the Face. Dermatol Pract Concept. 
2023;13(3):e2023188. DOI: https://doi.org/10.5826/dpc.1303a188

Accepted: March 6, 2023; Published: July 2023

Copyright: ©2023 Mkhinini 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: Haifa Mkhinini, Resident, Faculty of Medicine of Sousse Dermatology Department, Farhat Hached University 
Hospital, Sousse, Tunisia. E-mail: Haifa.mkhinini90@gmail.com

Case Presentation

A 48-year-old woman, with no medical history, presented 

with a unilateral asymptomatic facial lesion that had been 

evolving for 3 years. Dermatological examination revealed a 

linear erythematous plaque with open comedones on the sur-

face, located on the right infraorbital region (Figure 1A). The 

rest of the physical examination was unremarkable. Der-

moscopy revealed brownish keratotic plugs, milia-like cysts 

and telangiectatic vessels on an erythematous background 

(Figure 1B). Histopathological examination of a skin biopsy 

showed keratotic plugs and comedones, epidermal atrophy, 

vacuolar degeneration of the basal layer and dense perivas-

cular and periadnexal lymphocytic infiltrate (Figure 1C).  

Direct immunofluorescence revealed the presence of IgM, 

IgG, IgA and C3 deposits at the dermal-epidermal junction  

(Figure 1D). These findings were consistent with the diag-

nosis of comedonic lupus (CL). Antinuclear antibodies were 

positive (1:80), while systemic assessment results were neg-

ative. Hydroxychloroquine and sunscreen were prescribed.

Teaching Point

CL is a rare variant of chronic cutaneous erythematous lupus 

with a risk of systemic progression [1]. It usually appears as 

an erythematous pruritic comedonal plaque, on seborrheic 

regions, at the age of 25 to 35 years1,2. Although histopatho-

logical assessment is mandatory, dermoscopic examination 

can be useful to refine the diagnostic approach. Differential 

diagnoses include nevus comedonicus, Favre-Racouchot 

syndrome, lichen follicularis and acne vulgaris. Treatment 

is mainly based on photoprotection and oral hydroxychlo-

roquine. Other treatments can be used such as minocy-

cline, oral or topical retinoids and intralesional or topical 

corticosteroids1.



2 Image Letter | Dermatol Pract Concept. 2023;13(3):e2023188

Figure 1. (A) Infraorbital erythematous plaque with open comedones on the surface. (B) Dermoscopic image (Dermlite DL4, polarized 

mode) showing brownish keratotic plugs (black arrow) and milia-like cysts (black circle) on an erythematous background (white star).  

(C) Histological examination showing keratotic plugs and comedones (black stars), vacuolar degeneration of the basal cell layer (yellow 

arrow), periadnexal inflammatory infiltrate (green star) (H&E, x40). (D) Positive lupus band test on direct immunofluorescence.

References

1. Chessé C, Fernández-Tapia MJ, Borzotta F. Comedonic Lupus:  

An Unusual Presentation of Cutaneous Lupus. Actas Der-

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.ad.2019.07.013. E PMID: 33130011.

2. F. Hammami F, E. Bahloul E, A. Masmoudi A, et al. Le lupus 

comédonien : particularités cliniques et dermoscopiques. Annales 

de Dermatologie et de Vénéréologie. 2019;146(12):A217. DOI: 

10.1016/j.annder.2019.09.327.