Erythematous Plaques on the Eyelids

A 21-year-old black man presented to the dermatology clinic with a complaint of redness and swelling of the lateral aspect of his right lower eyelid that progressed to the left lower eyelid. These symptoms were exacerbated by exposure to sunlight. Physical examination revealed erythematous plaques with areas of hair loss and scarring of the lower eyelids (Figs 1 and 2). Results of initial laboratory examinations were significant for the following: antinuclear antibody titer, 1:80 (in a speckled pattern), and a normal angiotensin-converting enzyme concentration. The chest roentgenogram was normal. A biopsy specimen of the right lower eyelid was obtained for routine histologic studies (Figs 3 and 4) and direct immunofluorescence (Fig 5). What is your diagnosis?

Discoid lupus erythematosus (DLE).

The biopsy specimen of the right lower eyelid initially revealed mild-to-moderate chronic inflammatory changes with a patchy lymphohistiocytic infiltrate in a perivascular.