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Serologic methods currently in use for the study of systemic L.E. offer a possible means for early identification of that proportion of patients with a diagnosis of discoid L.E. who may develop generalized manifestations. Use of these methods in R group of sixteen patients with a diagnosis of chronic discoid L.E. reveals that some patients with only skin abnormalities may be found to have subtle immunopathologic manifestations which are strongly suggestive of the systemic disease.Methodos serologic que es currentemente in us0 in le studio de systemic lupus erythematose offere un medio possibile pro le precoce identification del proportion dc patientes con discoide lupus erythenintose in qui il existe le tendentia de iin futur disveloppamento de manifestationes generalisate. Le uso de iste methodos in un gruppo de decesex patientes con le diagnose de chronic discoide lupus erythematose ha revelate le possibilitate que certe patientes con anormalitates de solmente le pelle se distingue per subtil manifestationes immunopathologic que suggere fortemente le presentia del forma systemic del morbo.HE ORIGINAL clinical description of discoid lupus erythematosus was T recorded by Rayer in 1827, and a more complete account of the disease was given some 50 years later by Kaposi and Debra.' In 1924, Libman and Sacks2 drew attention to the disseminated form of lupus erythematosus. The relationship of the cutaneous disorder to the systemic illness has been noted in several clinical reviews.3-6 Although the occasional sequential occurrence of these clinical forms is not doubted, the significance of thc discoid form in pathogenesis and ultimate etiology of systemic lupus erythematosus (S.L.E.) remains a subject for debate.Approximately 20 to 25 per cent of patients with S.L.E. will have skin lesions indistinguishable from the chronic discoid type at some time in their clinical c o u r~e .~~~ Four to six per cent of individuals ultimately developing a multisystem syndrome compatible with S.L.E. will manifest only discoid cutaneous lesions for a considerable length of time before systemic symptoms develop.s Many clinicians are of the opinion that the two disorders are one and the same disease; others disagree because a considerable number of patients having only cutaneous lesions show no clinical laboratory or pathologic evidence of systemic involvement even after many years.lV9Adequate clinical and histopathologic criteria are pot defined for the dif-

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A 55-year-old Negro man noticed the development of a velvety, slightly verrucous hyperpigmented change in his axillae, groin and neck for about a year. There was also accentuation of the skin markings and deepening of his skin color in the same areas. The lesions were neither itchy nor painful but he lost his appetite and 10 pounds of weight over the preceding 6 months before he sought medical help.On the patient's first visit to his physician, a biopsy was taken from the affected area. This showed mild hyperkeratosis and papillomatosis with acanthosis. The dermal papillae were thinned, and the dermis contained a scanty chronic inflammatory infiltrate, primarily perivascular. Most of the consultants thought that the work-up should be oriented to a particular group of diseases.

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