Xanthomatous Discoid Lupus Erythematosus: An Unusual Histopathological Variant and Review of Reported Cases

Discoid lupus erythematosus (DLE) is the most common form of cutaneous lupus erythematosus and may lead to chronic scarring. Xanthomatous changes, characterized by dermal lipid-laden macrophages, are exceedingly rare, with only three cases reported to date. We present a patient with classic DLE lesions whose biopsy demonstrated CD68-positive foam cells and granular deposition of IgM, IgA, and C3 along the dermo-epidermal junction. Systemic evaluation revealed no abnormalities. The patient was treated with topical and systemic corticosteroids, resulting in partial clinical improvement. This fourth reported case underscores the importance of clinicopathologic correlation and further expands the recognized histopathological spectrum of DLE.