Sebaceous Granulomas: A Novel Feature of Discoid Lupus Erythematosus

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Professor, Consultant Pathologist, American Board Certified Pathologist, Fellow College of American Pathologists. Areas of interest Fine Needle Aspiration Cytology, Cytology, Cancer, Ethics, Islam, Humanity

Sebaceous Granulomas: A Novel Feature of Discoid Lupus Erythematosus

Rifat Yasmin, Ikramullah Khan, Anwar Ul Haque, Syed Afaq Ahmad

Objective: To determine the frequency of sebaceous granulomas formation in discoid lupus erythematosus.
Study Design: Retrospective observational study.
Setting: Departments of Dermatology and Pathology, Pakistan Institute of Medical Sciences, Islamabad.
Material and Methods: 100 cases of Discoid Lupus Erythematosus (DLE)spanning over two years and with the age range of 3 years to 70 years were examined for the presence of Sebaceous Granuloma. Other features of DLE like hyperkeratosis, follicular plugging, epidermal atrophy, basal layer vacuolization, basement membrane deposits, pigmentary incontinence, perivascular inflammation, periappendigeal inflammation, and collagen damage were also noted.
Introduction: Lupus erythematosus is an immune complex, type III hypersensitivity disease where antibodies are formed against native Deoxyribose Nucleic Acid (DNA). The immune compexes are deposited in various organs and various sites causing marked pleotropism. If several systems are involved then the disease is named Systemic Lupus Erythematosus (SLE) and if skin is exclusively involve the term Discoid Lupus Erythematosus (DLE) is used. One of the several features of DLE includes periappengeal inflammation. This may at times completely wipe out sebaceous glands forming sebaceous granulomas.
Results: Out of these 100 cases 8 cases contained sebaceous granulomas. These granulomas were composed of epithelioid cells, foreign body giant cells containing partially digested sebaceous material and a few lymphoctytes.
Conclusion: Sebaceous granulomas formation was seen in 8 % cases of discoid lupus erythematosus. This feature must be recognized both by dermatologists and pathologist so that diagnosis of DLE may not be distracted and erroneous diagnosis due to presence of granulomas may not be rendered.
Key Words: Discoid lupus erythematosus (DLE), Systemic Lupus Erythematosus (SLE), periappendageal inflammation, chronic granulomatous inflammation, sebaceous granulomas.


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