Lupus Erythematosus Profundus with Multiple Overlying Cutaneous Ulcerations: A Rare Case

Endang Sutedja,1 Muhamad Radyn Haryadi Widjaya,1 Hartati Purbo Dharmadji,1 Oki Suwarsa,1 Miranti Pangastuti,1 Hermin Aminah Usman,2 Chaerani Pratiwi Firdaus1 1Department of Dermatology and Venereology, Faculty of Medicine, Universitas Padjadjaran - Dr. Hasan Sadikin Hospital, Bandung, West Java, Indonesia; 2Department of Anatomical Pathology, Faculty of Medicine, Universitas Padjadjaran - Dr. Hasan Sadikin Hospital, Bandung, West Java, IndonesiaCorrespondence: Endang Sutedja, Department of Dermatology and Venereology, Faculty of Medicine, Universitas Padjadjaran - Dr. Hasan Sadikin Hospital, Jl. Pasteur 38, Bandung, West Java, 40161, Indonesia, Tel +62222032426 ext. 3449, Fax +62222032426, Email endangsutedja@ymail.comAbstract: Lupus erythematosus profundus (LEP) is a rare subset of chronic cutaneous lupus erythematosus (CCLE), with a reported incidence of 1– 3% in all LE cases. The most common cutaneous clinical presentation includes indurated plaques or subcutaneous nodules with an overlying normal skin. The clinical findings range from skin redness to features of CCLE, such as scaling, follicular plugging, and atrophy. Ulceration is rare and occurs in 28% of all LEP cases. We present a case report of LEP with multiple cutaneous ulcers on the right cheek and scalp accompanied by cicatricial alopecia. No other systemic manifestations were noted. Histopathological examination revealed periadipocyte, perivascular, and perivascular infiltration of lymphocytes, eosinophils, and plasma cells, supporting the diagnosis of LEP. The topical treatments given to the patient were sunscreen, 2% mupirocin cream, and wound dressing with dialkyl carbamoyl chloride (DACC). The patient was also treated systemically with oral corticosteroids and hydroxychloroquine. Clinical improvements were observed in the 3rd month of follow-up, and ulcer healing resulted in atrophic scars and fading erythematous macules. LEP is seldom associated with systemic or discoid lupus erythematosus. This occurs twice as frequently as a distinct entity does. Diagnosis accuracy plays an important role in determining the appropriate wound care, topical, and systemic treatments for LEP patients with multiple overlying cutaneous ulcerations.Keywords: cutaneous ulcerations, lupus erythematosus profundus, multiple, rare case