LAUSR

ANA: antinuclear antibody CCLE: chronic cutaneous lupus erythematosus DLE: discoid lupus erythematosus LE: lupus erythematosus LET: lupus erythematosus tumidus SLE: systemic lupus erythematosus INTRODUCTION Alopecia in varying patterns is a common feature of lupus erythematosus (LE). Several forms of alopecia that are not specific to LE can occur in the setting of lupus, such as alopecia areata, telogen effluvium, and anagen effluvium. LE-specific alopecias are those with a histology consistent with LE and include forms of acute, subacute, and chronic cutaneous lupus. Common patterns of LE-specific alopecia include the nonscarring diffuse hair thinning and fragility of acute LE and the scarring, erythematous scaly plaques with follicular keratotic plugs, peripheral hyperpigmentation, and central hypopigmentation of discoid lupus (DLE). Lupus erythematosus tumidus (LET) may also present on the scalp as well-defined, nonscarring alopecia without overlying scale, atrophy, and dyspigmentation—lesions clinically reminiscent of alopecia areata, albeit with different underlying histopathology. We report on 2 male patients with large circular nonscarring alopecic plaques on the scalp without overlying scale or erythema but with central hyperpigmentation and scarring. Biopsies found patchy perifollicular and focally lichenoid lymphocytic infiltrate with loss of hair follicles and increased dermal mucin consistent with LE; further workup and serologic testing found systemic lupus. These 2 cases demonstrate an unusual clinical presentation of central scarring alopecia within a larger nonscarring alopecic plaque in the setting of SLE that deviates from typical lupusrelated alopecia.