Localized chronic cutaneous lupus erythematosus masquerading as pigmented lesions: a new clinical subset?

Isolated, hyperpigmented lesions arising on the skin of the head and neck in the elderly rarely prompt consideration of connective tissue diseases. Histologic evaluation, however, may reveal changes compatible with chronic cutaneous lupus erythematosus (CCLE). A retrospective review of cutaneous biopsies compatible with CCLE evaluated by the Vanderbilt University Division of Dermatopathology over a five-year period (1998-2002) was undertaken. Cases with isolated lesions arising on the head and neck in patients 40 years or older were selected and the histopathology was confirmed. Patients were interviewed by phone and their charts were reviewed. A total of 11 cases were found, including nine women and two men. These patients averaged 68 years of age and presented with single, hyperpigmented macular lesions. Photosensitivity was rare and no associated stigmata of lupus erythematosus were noted. Response to topical application of corticosteroid preparations was excellent.