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Updated: May 29, 2026
Skin Biopsy for Diagnosing Discoid Lupus Erythematosus
Published on: June 10, 2025
Hypertrophic lupus erythematosus: the diagnostic utility of CD123 staining
Christine J Ko1, Bhaskar Srivastava, Irwin Braverman
1Department of Pathology, Yale University School of Medicine, New Haven, CT, USA. christine.ko@yale.edu
Insights
CD123-positive cells are abundant in hypertrophic lupus erythematosus (LE) but scarce in squamous cell carcinoma (SCC) and actinic keratosis (AK). This finding aids in differentiating hypertrophic LE from these skin conditions.
Area of Science:
- Dermatopathology
- Immunohistochemistry
- Cutaneous Oncology
Background:
- Plasmacytoid dendritic cells (pDCs), identified by CD123 expression, are implicated in the pathogenesis of discoid lupus erythematosus (LE).
- Distinguishing hypertrophic LE from cutaneous malignancies like squamous cell carcinoma (SCC) and actinic keratosis (AK) can be challenging histopathologically.
Purpose of the Study:
- To investigate the presence and pattern of CD123-positive cells in hypertrophic LE.
- To evaluate the utility of CD123 staining in differentiating hypertrophic LE from SCC and hypertrophic AK.
Main Methods:
- Immunohistochemical staining for CD123 was performed on tissue samples.
- Five cases of hypertrophic LE and ten cases each of SCC and hypertrophic AK were analyzed.
Main Results:
- A dense band of CD123-positive cells was observed at the epidermal-dermal junction in all hypertrophic LE cases.
- Only single or rare scattered clusters of CD123-positive cells were detected in SCC and hypertrophic AK specimens.
Conclusions:
- CD123 staining patterns can serve as a valuable diagnostic marker.
- This immunohistochemical approach aids in the histopathologic distinction between hypertrophic LE and its mimics, SCC and AK.
Abstract:
CD123-positive plasmacytoid dendrocytes are prominent in the infiltrate of discoid lupus erythematosus (LE). We hypothesized that these cells would also be present in hypertrophic LE and would aid in the histopathologic distinction from squamous cell carcinoma (SCC) and hypertrophic actinic keratosis (AK). Five cases of hypertrophic LE and 10 cases each of SCC and hypertrophic AK were stained with CD123. A heavy band of CD123-positive cells was present at the epidermal-dermal junction in all cases of hypertrophic LE, and only single or rare scattered clusters of CD123-positive cells were seen in SCC and actinic keratoses. The pattern of CD123 staining can be a useful feature to distinguish hypertrophic LE from SCC and hypertrophic AK.
