Case of persistent swollen eyelids for 3 years - Lancet

An interesting case of discoid lupus erythematosus (DLE) with persistently swollen eyelids appeared in the journal The Lancet. Yuka Maya and associates describe the case of a 44-year-old woman presented with a 3-year history of having swollen and red eyelids. The problem was not associated with pruritus or pain.

She had been previously treated with topical steroids and antibiotics but with little effect. Her past medical history was unremarkable. During the physical examination, she was found to have scaly, atrophic, erythematous plaques—with the loss of eyelashes on the lateral aspects—on both lower eyelids as shown in the figure. Additionally, the scaly erythema was accompanied by hyperpigmentation on the left lateral canthus as shown in the figure. There were no other skin or mucosal lesions.

Figure: Red and swollen eyelids; Courtesy-The Lancet

Histological examination of the lesions showed follicular plugging, epidermal atrophy, liquefaction degeneration of epidermal basal cells, and dermal perivascular and periadnexal lymphocytic infiltration. Direct immunofluorescence revealed a linear deposition of immunoglobulin M (IgM) at the dermo-epidermal junction. She was diagnosed as having discoid lupus erythematosus (DLE); she did not meet the criteria for systemic lupus erythematosus (SLE).

She was advised to avoid ultraviolet light by wearing sunglasses and sunscreen. She was also treated with oral hydroxychloroquine 300 mg/day for 16 weeks. The DLE lesions completely remitted without the improvement of the madarosis.

Discoid lupus erythematosus (DLE) is a chronic skin condition of sores with inflammation and scarring favoring the face, ears, and scalp and at times on other body areas. These lesions develop as a red, inflamed patch with a scaling and crusty appearance.

For reference log on to https://doi.org/10.1016/S0140-6736(18)32327-4