Acneiform lesions in a 57-year-old woman

A 57-year-old woman on leflunomide with a history of chronic obstructive pulmonary disease and rheumatoid arthritis presented with multiple flesh-colored to hyperpigmented dome-shaped papules, scattered comedones, and underlying scarring on bilateral cheeks and chin. These dermatologic manifestations, laboratory evaluation, and punch biopsy led to a final diagnosis of acneiform or comedonal discoid lupus erythematosus (ACDLE). For patients with acneiform or comedonal lesions, ACDLE should be considered if the lesions do not improve with conventional treatment for acne vulgaris.