Details
40-year-old female with three months history of deep nodular skin lesions on the arms.
Lupus Erythematosus Profundus (LEP) is one of the subtypes of cutaneous Lupus erythematosus (skin-limited Lupus), which is an autoimmune disease.
Clinically, LEP is common in women of childbearing age. It appears as erythematous, deep, tender plaques and nodules in the proximal extremities, trunk, and face. Microscopically, LEP typically shows prominent histopathologic changes in the dermis and subcutaneous adipose tissue of the skin. The dermis shows marked, intense, superficial and deep perivascular, and periappendageal small non-atypical lymphocyte infiltrates. Admixed plasma cells are noted, but otherwise there is no significant mixed inflammatory background.
Prominent dermal mucin deposition is also seen (and may be demonstrated by Hale's colloidal iron stain). There is prominent hyalinizing fat necrosis in the dermal-subcutaneous junction. Because of this, to make a definitive diagnosis of LEP, a deep punch biopsy is indicated to obtain appropriate subcutaneous tissue.