Discoid Lupus Erythematosus

Follicular red dots

Discoid lupus (DLE) of the scalp is one of the scarring alopecias. It’s important to recognize early because regrowth can sometimes occur with aggressive treatment. DLE can sometimes mimic another scarring alopecia known as lichen planopilaris and sometimes even looks like alopecia areata. The use of a dermatoscope can help correctly identify DLE. In 2009 Antonella Tosti described “follicular red dots” as an important feature of DLE. Biopsies of these dots showed they represented hair follicles plugged by keratin. Dilated blood vessels and extravasated red blood cells into the upper follicle (isthmus) contribute to the red color. The arrows in the photo point to follicular red dots. Early lesions of DLE show perifollicular whitish halos around hairs, white scales and follicular plugging. Later on in the disease course, hyperpigmentation, white structureless areas and telangiectatic vessels are seen. 
Follicular red dots are often seen in DLE but are non specific. They can be seen in the eyebrow in frontal fibrosing alopecia and sometimes in normal skin.
 

Reference

Tosti et al. Arch Dermatol 2009.