Discoid lupus erythematosus presenting as acneiform pitting scars

A 32-year-old man presented with conspicuous acneiform pitting scars on the right nasolabial fold of 3 years' duration (Fig. 1). He stated that the scars were preceded by erythematous plaques. Physical examination also revealed perilesional erythematous infiltration and telangiectasia. Tracing back the history, there was no malar erythema, oral ulcer, or arthralgia. A skin biopsy showed irregular acanthosis, follicular plugging, vacuolar degeneration of the basal cell layer with marked melanin incontinence, and heavy periadnexal mononuclear cell infiltration (Fig. 2a,b). Direct immunofluorescence studies displayed continuous granular deposition of immunoglobulin G (IgG) and C3 along the dermo-epidermal junction. The hemogram, antinuclear antibody (ANA) test, complement, and urinalysis were within normal limits. Based on the histopathologic findings and a positive lupus band test, a diagnosis of discoid lupus erythematosus (DLE) was made.