Discoid lupus ("DLE") of the Scalp
DLE is a scarring hair loss condition that can mimic many conditions. It can sometimes look like alopecia areata and it can sometimes look like lichen planopilaris. The importance of diagnosing DLE properly is that some patients (5%) with DLE have a disease affecting the entire body called systemic lupus erythematosus (SLE).
This photo shows a patient with discoid lupus misdiagnosed as alopecia areata. In this photo we see pili torti (labelled number 1), follicular keratotic plugs (labelled number 2) and follicular red dots (labelled 3). In 2009, Antonella Tosti and colleagues reported that follicular red dots are dermatoscopic features of DLE. Biopsies of these dots showed they actually represent follicles plugged by keratin. The redness comes from the dilated blood vessels and extravasated red blood cells in the area. Tosti and colleagues emphasized the importance of the follicular nature of these red dots.
Dr. Jeff Donovan is a Canadian and US board certified dermatologist specializing exclusively in hair loss. To schedule a consultation, please call the Whistler office at 604.283.1887