A Clinical and Histopathological Review of Chronic Cutaneous Lupus Erythematosus Alopecia in Korea

Chae, Myeong Heon; Lee, Ji Yeoun; Yoon, Tae Young

Abstract

BACKGROUND
Chronic cutaneous lupus erythematosus (CCLE) often affects the scalp and results in alopecic lesions. To date, no studies have examined CCLE alopecia in Korea.
OBJECTIVE
The aim of this study was to investigate the clinical and histopathological features of CCLE alopecia in Korean patients. In addition, we reviewed the histopathological features that could potentially affect treatment response.
METHODS
A retrospective study was conducted on 20 patients who were diagnosed with CCLE alopecia of the scalp between 1998 and 2018. We reviewed the clinical and histopathological features of CCLE alopecia and compared the treatment response according to the histopathological features.
RESULTS
Among the 20 CCLE alopecia patients, 13 patients (65%) were diagnosed with discoid lupus erythematosus (DLE) and 7 patients (35%) with lupus erythematosus panniculitis (LEP). The most frequently affected site was the vertex, and 65% of the patients had multiple lesions at the time of diagnosis. Common clinical features were erythema, atrophy, and hyperpigmentation. Histopathologically, dermal mucin deposition and a lymphocytic infiltrate around the mid to lower portion of the hair follicles were common. Among the treated patients, hair regrowth was observed in 42.9% of DLE patients and in 100% of LEP patients at the margin of the existing lesion. According to the histopathological features, the group exhibiting a reduction of sebaceous glands showed no hair regrowth.
CONCLUSION
The novel finding in this study was that the treatment effect was decreased in patients with sebaceous gland reduction. Further study is needed to determine whether the reduction of sebaceous glands reflects the permanent destruction of hair follicular stem cells or whether it acts as the primary cause of the permanent destruction of hair follicles in DLE alopecia.