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Correspondence
March 2009

Tumid Lupus Erythematosus at the Site of a Scar

Arch Dermatol. 2009;145(3):343-344. doi:10.1001/archdermatol.2008.615

A 30-year-old white woman presented with persistent asymptomatic plaques at the site of a scar that started about 4 weeks after she had undergone revision lumbar spinal surgery. She reported having similar plaques in the same location after her first spinal surgery. The lesions persisted for a few months and topical corticosteroids were used with uncertain efficacy. She denied the use of other topical drugs at the surgical site or exposure to new systemic medications and has no personal or family history of connective tissue disease. On examination, she was found to have indurated, erythematous, nonscaly plaques on and adjacent to the surgical scar (Figure 1). Histologic examination revealed a dense superficial and deep dermal, perivascular, lymphocytic infiltrate associated with perifollicular and eccrine apparatus involvement; significantly increased mucopolysaccharide deposition throughout the dermis (Figure 2A) confirmed with colloidal iron stain1; and focal subtle basal keratinocytic vacuolar changes. Thickening of the basement membrane was not noted with periodic acid–Schiff stain. Direct immunofluorescence (DIF) revealed granular deposits of IgM, IgG, C3, and C5b-9 that were more prominent along the adnexal than the epidermal basement membrane zone (Figure 2B). The lymphocytic infiltrate was composed mostly of T cells, with a CD4:CD8 ratio of 4:1. Test results including from antinuclear antibody screen by immunofluorescence and anti-Ro, anti-La, anti-Sm, antiribonucleoprotein, and anti–double-stranded DNA antibody enzyme-linked immunosorbent assay, urinalysis, and other routine laboratory studies were all negative or within the normal range. Levels of total hemolytic complement, C3, and C4 were all normal as was the erythrocyte sedimentation rate. The eruption persisted for 4 to 6 months followed by complete resolution. Few recurrences were noted, and these recurrences responded partially to treatment with topical high-potency corticosteroids and short courses of tapering oral prednisone starting at 20 mg/d.

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