Diagnosis: Lupus Erythematosus Panniculitis

Lupus panniculitis, or lupus profundus, represents 2%-3% of all patients with lupus erythematosus.  It most commonly occurs in adults aged 20-60.  Patients present with tender subcutaneous nodules and plaques that tend to develop on the face, upper outer arms, shoulders, hips, and trunk.  The distal extremities are usually spared. The overlying skin can show features of chronic cutaneous lupus including scaling, follicular plugging, atrophy, dyspigmentation, telangiectasias, and ulceration.  

Histopathology reveals a primarily lobular panniculitis with a marked predominance of lymphocytes and scattered plasma cells. One characteristic feature is hyalin necrosis of fat lobules that can extend into the septa.

Treatment options include sunscreen, potent topical and intralesional corticosteroids, antimalarials, systemic steroids (in initial phases of disease), dapsone, cyclophosphamide, and thalidomide. This patient was treated with thalidomide, which resulted in improvement of his lesions.

This case was first presented at Maryland Derm, at the University of Maryland School of Medicine in Baltimore, by Dr. Bilu Martin and Dr. Anthony Gaspari.

Images courtesy Dr. Donna Bilu Martin

Histology shows a lobular panniculitis with a marked predominance of lymphocytes and scattered plasma cells.