Sebaceous Granulomas: A Novel Feature of Discoid Lupus Erythematosus

Abstract

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