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August 2007

A Scaly Plaque on the Scalp—Quiz Case

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Arch Dermatol. 2007;143(8):1067-1072. doi:10.1001/archderm.143.8.1067-d

A 58-year-old black man was referred by his nephrologist to the dermatology clinic for evaluation of a scaly plaque on his scalp before renal transplantation. At that time, he was receiving hemodialysis for hypertensive nephropathy, with no evidence of systemic lupus erythematosus. He could not recall the duration of the plaque but reported an approximate 20-year history of a scarring patch on his scalp. A similar lesion on his arm had been biopsied and diagnosed as discoid lupus erythematosus (DLE). He had no family history of skin or connective tissue disorders. Physical examination revealed a 2.8×4.8-cm verrucous plaque situated at the right frontal aspect of a 7×9-cm atrophic, hairless, depigmented patch on his scalp (Figure 1). There was no associated cervical lymphadenopathy. A shave biopsy specimen was obtained (Figure 2 and Figure 3).

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