Comedonal Plaques With Scarring Alopecia on the Scalp: A Case Report

Comedonal discoid lupus erythematosus (DLE) is a rare variant of chronic cutaneous lupus erythematosus, often posing diagnostic challenges due to its atypical acneiform presentation. We report a case of a 52-year-old male presenting with alopecia and hypertrophic plaques on the scalp, characterized by follicular plugging, open comedones, and dermatoscopic findings of telangiectasias, scattered pigmentation, and follicular loss. Histopathology revealed hallmark features of DLE, including basal layer liquefaction and perifollicular lymphocytic infiltration. Anti-nuclear antibody testing and systemic lupus erythematosus (SLE) workup were negative. Despite its rarity, early recognition of comedonal DLE is critical to prevent scarring alopecia and ensure timely treatment, which includes strict photoprotection, topical corticosteroids, and systemic hydroxychloroquine. This report underscores the importance of considering DLE in cases of refractory acneiform lesions with atypical clinical features.