Abstract

Lupus Erythematosus (LE) is a chronic and multisystemic autoinflammatory disease that often affects the skin. Cutaneous manifestations of lupus erythematosus show a great variation and are usually classified as acute cutaneous LE (ACLE), subacute cutaneous LE (SCLE), and chronic cutaneous LE (CCLE). Discoid lupus erythematosus (DLE) is the most common subtype of CCLE which usually begins with well-demarcated,  flat or slightly elevated, red-purple and scaly macules or papules that evolves to distinct, larger coin-shaped “discoid” scaly plaques. We describe an unusual variant of DLE which is presented as extensive verrucous plaques. A 54-year-old male who is diagnosed with cutaneous LE at the age of 26, presented with multiple hypopigmented and scaly verrucous plaques involving the scalp, face, neck, and chest. The biopsy of the lesion on the chest showed hypertrophic glassy epithelium with squamatization and dense lymphocytic infiltrate which is consistent with hypertrophic lupus erythematosus. The patient reported a decrease in the size of the lesions and increased pigmentation after starting hydroxychloroquine. Hypertrophic DLE or verrucous LE is an unusual version of CCLE. It was first described by Bechet in 1942 and represents approximately 2% of chronic cutaneous LE cases. The morphology of the lesions may be observed as depigmented atrophic plaques or disseminated keratoacanthoma-like verrucous lesions. Differential diagnosis includes hypertrophic psoriasis, lichen planus, verrucae, keratoacanthoma, or squamous cell carcinoma The potential to develop malignancy is usually a concern in long-standing chronic cases with therapeutic failure.