Microscopic examination of a biopsy specimen from the cutaneous outer aspect of the eyelids revealed parakeratosis, atrophy, and a subepidermal lymphohistiocytic infiltrate localized around hair follicles, vessels, and muscle fibers. In addition, there were eosinophilic intraepidermal bodies, vacuolar change in the basal layer, and eosinophilic amorphous subepidermal material. The dermis also contained some elanophages, and mucin was noted on staining with alcian blue. Microscopic examination of a biopsy specimen from the mucosal inner aspect of the eyelid showed a lymphohistiocytic, erosive infiltrate at the dermoepidermal junction. Direct immunofluorescence staining from involved skin revealed globular fluorescence along the dermoepidermal junction with C3 and C4. The results of direct immunofluorescence of uninvolved sun-exposed skin were negative. The findings of routine laboratory and autoantibody tests (antinuclear antibody, extractable nuclear antigen, anti-Ro/SSA, and anti-La/SSB) were all normal or negative. Instrumental evaluations did not reveal systemic alterations.
Chronic Erythematous Desquamative Plaques of the Eyelids. Arch Dermatol. 2002;138(4):527-532. doi:10.1001/archderm.138.4.527