Challenge

Solitary hypertrophic lupus erythematosus of the nose without other cutaneous or systemic involvement

“…The present case shows that HLE is difficult to diagnose because it is an unusual disease that closely resembles other skin conditions, particularly when it does not occur in a setting of typical CCLE, as in our patient. To our knowledge, only one case of “solitary” HLE has been reported in the literature, 3 and thus the present patient represents the first case of HLE to be successfully treated with adapalene.…”

“…First described by Bechet 1 in 1940, HLE is a distinct and very uncommon subtype of CCLE. Occurring in approximately 2% of patients with CCLE, 2–4 HLE is clinically characterized by dull, hard, erythematous, verrucous, and usually asymptomatic plaques and nodules with hyperkeratotic scales, mainly affecting photoexposed areas 2,3 …”

“…It is uncommon in the context of SLE, and patients rarely have positive serologic tests 2,4 . Two histologic variants of HLE have been described as lichen planus‐like and keratoacanthoma‐like patterns 2,3 . The distinction of HLE from keratoacanthoma, hypertrophic lichen planus, and squamous cell carcinoma (SCC) may represent a challenge for clinicians and pathologists as these conditions share several morphologic and histologic characteristics and because SCC may arise in HLE.…”

“…Therapeutic options include retinoids, intralesional and topical steroids, antimalarials, surgical excision, and thalidomide, associated with sun avoidance 2–4 . Retinoids, such as acitretin, etretinate, and systemic and topical tretinoin isotretinoin, have shown efficacy in HLE, even when it is recalcitrant to conventional therapy 2–9 …”