Dermatology: Practical and Conceptual Research Letter | Dermatol Pract Concept. 2024;14(4):e2024251 1 Dermatoscopy of Comedogenic Lupus Erythematosus Riccardo Curatolo1, Hazem A. Juratli1,2,3, Mara Lynda Zehnder¹, Matiar Madanchi1 1 Department of Dermatology, University Hospital of Basel, Basel, Switzerland 2 Department of Dermatology, Dermatopathology Training Center, University Hospital Basel, Basel, Switzerland 3 Institute of Medical Genetics and Pathology, University Hospital Basel, Basel, Switzerland Key words: Dermatoscopy, comedogenic Lupus Erythematosus, Diagnosis Citation: Curatolo R, Juratli HA, Zehnder ML, Madanchi M. Dermatoscopy of Comedogenic lupus erythematosus. Dermatol Pract Concept. 2024;14(4):e2024251. DOI: https://doi.org/10.5826/dpc.1404a251 Accepted: May 8, 2024; Published: October 2024 Copyright: ©2024 Curatolo 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: Matiar Madanchi, Burgfelderstrasse 101, 4055 Basel (Switzerland). Phone: +41612654080 E-mail: matiar.madanchi@usb.ch Case Presentation A 52-year-old woman presented with a 3-year history of a scarring erythematous lesion on her left chin. Initially di- agnosed with folliculitis, she underwent various topical treatments and systemic isotretinoin, without improvement. On reevaluation, a hypotrophic scarring plaque was noted (Figure 1A). Dermoscopy revealed multiple comedones with diffuse arborizing telangiectasia, partially scarred areas, and white dots (Figure 1B). Histopathologic examination demonstrated a lichenoid inflammation and interface der- matitis with mucin and CD-123 positive cells, leading to a diagnosis of comedogenic lupus erythematosus, a variant of chronic cutaneous lupus erythematosus. Teaching Point Comedogenic lupus erythematosus (CLE) is a rare variant of chronic cutaneous lupus erythematosus (CCLE) often initially misdiagnosed as other folliculocentric dermatoses. This initial misdiagnosis can lead to delayed intervention, resulting in disease progression and disfigurement. Dermo- scopic examination plays an important role in distinguishing CLE from other conditions, revealing characteristic findings such as comedones, telangiectasia, and scarring. Histologi- cally, CLE is characterized by the identification of lichenoid inflammation with mucin deposition and CD-123 positive cells, aiding in the accurate diagnosis of CLE. Timely recognition of CLE is paramount to prevent long-term sequelae. Effective management of CLE remains challenging. Photoprotection is extremely important, as in all other variants. Consideration could be given to initiat- ing treatment with topical retinoids or steroids; however, in many cases, systemic treatment with hydroxychloroquine is often required and considered the first line of treatment [1, 2]. Furthermore, understanding the clinical, dermo- scopic, and histological features of CLE is essential for dermatologists to provide optimal care. 2 Research Letter | Dermatol Pract Concept. 2024;14(4):e2024251 References 1. Haroon TS, Fleming, KA. An unusual presentation of discoid lupus erythematosus. Br J Dermatol. 1972;87(6):642-645. DOI:10.1111/j.1365-2133.1972.tb07456.x. Figure 1. (A) Hypotrophic scarring plaque on the left chin. (B) Dermoscopic features, including comedones with diffuse arborizing telangiectasia, partially scarred areas, and white dots. 2. Hemmati I, Otberg N, Martinka M, Alzolibani A, Restrepo I, Shapiro J. Discoid lupus erythematosus presenting with cysts, com- edones, and cicatricial alopecia on the scalp. J Am Acad Dermatol. 2009;60(6):1070-1072. DOI:10.1016/j.jaad.2008.11.882