Dramatic Response of Scarring Scalp Discoid Lupus Erythematosus (DLE) to Intravenous Methylprednisolone, Oral Corticosteroids, and Hydroxychloroquine in a 5‐Year‐Old Child

Abstract

Discoid lupus erythematosus (DLE) is rare in childhood. We report the case of a 5-year-old girl who presented with erythematous scaly plaques, with scarring alopecia, involving approximately 40% of her scalp. Histopathology confirmed the diagnosis of DLE. Treatment with intravenous methylprednisolone, hydroxychloroquine, oral prednisone, topical corticosteroids, and sunscreen lead to reversal of scarring alopecia and re-growth of hair.

A Practical Approach to the Diagnosis and Management of Hair Loss in Children and Adolescents

“…Although there is a female predominance in adult DLE, there is no sex predilection in children. Antinuclear antibodies are uncommon in children (26%), as opposed to 43% positivity in adults; however, progression to systemic lupus erythematosus (SLE) is more common in children with 26% over a 3-year period developing SLE in contrast to only 5% of adults (74). One retrospective study of 40 children with DLE reported the greatest risk of progression to SLE was in the first year after DLE diagnosis.…”

A 14-year-old boy with an irregularly bordered, erythematous, alopecic patch of the scalp

“…The healthy status of the patient, the poor discomfort related to the plaque, and its apparent stability made us decide for topical steroids rather than oral antimalarials or systemic steroids. [2] During the day, he was suggested to avoid sun exposure. A strict follow-up has then been planned with a dermatological consultation every 3 months and a systemic screening once a year.…”

Current treatment strategies: Collagen vascular diseases in children

“…In limited skin lesions not responding to topical therapy, oral hydroxychloroquine should be started. [5]…”

“…In severe cases intravenous methylprednisolone pulse therapy may be given. [5] Children on hydroxychloroquine therapy need baseline and thereafter routine ophthalmic check up. Miettunen et al .…”

“…Miettunen et al . [5] reported a 5-year-old girl with rapidly progressive scalp DLE with scarring, whom they treated with methylprednisolone pulse therapy (10 mg/kg/day for 3 days), single dose, followed by hydroxychloroquine, oral prednisolone, and topical amcinonide (0.1%) lotion. This treatment regimen resulted in complete regrowth of scalp hair without recurrence during follow up.…”