This clinical photograph displays a superior view of the scalp demonstrating classic features of Discoid Lupus Erythematosus (DLE). The image reveals extensive, patchy scarring alopecia (cicatricial alopecia) characterized by a significant reduction in hair density and visible destruction of hair follicles. The skin lesions exhibit a tri-colored, variegated appearance: erythematous (pink-red) areas indicating active inflammation, hyperpigmented (brown-tan) macules and patches, and focal regions of porcelain-white hypopigmentation suggestive of established dermal fibrosis and scarring. The distribution is irregular across the vertex and crown, showing the progressive nature of the follicular damage. This visual serves as a primary educational example of the cutaneous manifestations of chronic cutaneous lupus erythematosus on the scalp, emphasizing the transition from active inflammatory plaques to permanent, irreversible hair loss.

Clinical photography of the scalp in a patient with discoid lupus erythematosus (DLE) demonstrating cicatricial (scarring) alopecia in the occipital/posterior scalp. The image shows localized, erythematous to hypopigmented plaques with adherent scales and follicular plugging, surrounding areas of atrophic scarring and reduced hair density. The hair is finely distributed around the lesion with thinning indicative of irreversible follicular destruction. There is a central koebnerized-like scar with cribriform appearance and irregular, raised borders consistent with chronic inflammatory scarring alopecia. Vascularity appears mild, with pale, scarred skin in the center and erythematous periphery. The clinical presentation aligns with discoid lupus activity: chronic, scarring lesions that may progress to permanent hair loss if untreated. The image underscores typical features of DLE on the scalp: well-demarcated plaques, follicular plugging, hyperkeratosis, and central alopecic patches. Color balance and lighting emphasize subtle redness, scale, and atrophic skin. This photograph is useful for educational purposes, differential diagnosis against other causes of cicatricial alopecia (lichen planopilaris, frontal fibrosing alopecia, traction alopecia), and for teaching clinicians about the appearance of DLE lesions in acral and scalp regions. Potential clinical applications include diagnosis confirmation, treatment planning, dermatopathology correlation, and monitoring disease progression or response to antimalarial therapy.

A composite of three clinical photographs showing the face and scalp of a patient with chronic cutaneous lupus erythematosus (CCLE), specifically discoid lupus erythematosus (DLE). The frontal and lateral views of the face demonstrate multiple well-demarcated, erythematous, atrophic patches of varying sizes. These lesions are located on the nasal bridge, cheeks, temples, jawline, and ears. Key morphological features include central atrophy and scarring with peripheral hyperpigmentation and active erythema. The posterior view of the scalp reveals significant multifocal cicatricial (scarring) alopecia. The hair loss areas directly correspond to the presence of large, irregular, confluent erythematous and depigmented patches. The scalp lesions show a complete loss of follicular ostia within the atrophic centers, characteristic of permanent hair loss in DLE. This visual series illustrates the classic distribution and morphology of discoid rash affecting both glabrous skin and hair-bearing areas in an adult patient.

This dermatologic clinical photograph depicts a discoid lupus erythematosus (DLE) lesion on the scalp with resulting cicatricial (scarring) alopecia. The image shows an irregular, hypopigmented-to-erythematous plaque at the scalp margin with a central area of hair loss and complete disruption of hair follicles, producing permanent scarring. The patch is bordered by a slightly erythematous, scaly margin and perifollicular hyperpigmentation. Follicular openings are diminished or obliterated in the affected zone, consistent with cicatricial alopecia. The surrounding skin may appear atrophic, with subtle pigmentary changes typical of chronic discoid lupus. Clinically, the pattern is localized and plaque-like, most commonly affecting sun-exposed scalp regions; DLE lesions may coalesce or evolve over weeks to months. This entity is part of the lupus erythematosus spectrum and carries diagnostic significance for autoimmune dermatology; histopathology would reveal interface dermatitis with basal cell vacuolization, periadnexal lymphocytic infiltrate, follicular plugging, and dermal sclerosis. Differential diagnosis includes lichen planopilaris, frontal fibrosing alopecia, and other scarring alopecias. Management implications include antimalarial therapy, topical steroids, calcineurin inhibitors, photoprotection, and rheumatology assessment for systemic involvement. This image serves educational purposes for dermatology, rheumatology, and medical training in recognizing cicatricial alopecia patterns associated with discoid lupus.

Clinical photography of facial skin illustrating discoid lupus erythematosus (DLE) with sun-exposed-area involvement. Frontal/anterior view of the face shows multiple erythromatous plaques on the cheeks, nasal bridge, perioral region, and ears, with overlying adherent scales and peripheral erythema. Lesions are firm and may exceed several centimeters; keratin plugs are often evident beneath scales when removed. Chronic plaques exhibit atrophic scarring and pigmentary alteration, including hypopigmentation in darker skin tones; depigmentation can be disfiguring and scalp involvement suggests long-standing, severe disease. Early lesions may be erythematous and edematous before plaque formation. The distribution pattern is predominantly head and neck in localized DLE but can extend to non-exposed sites in generalized disease; photosensitivity with seasonal exacerbations in spring/summer is typical. Clinically, the appearance—well-demarcated, scale-covered plaques on sun-exposed skin—helps distinguish DLE from seborrheic dermatitis, rosacea, and actinic damage; differential includes lupus erythematosus profundus, psoriasis, and granulomatous diseases. The image underscores the importance of sun protection, topical corticosteroids or calcineurin inhibitors, and potential antimalarial therapy in management. This photographic reference is valuable for dermatology education, augmenting recognition of cutaneous lupus manifestations, scarring alopecia risk, and the need for biopsy confirmation when systemic involvement is uncertain. Images like this support diagnostic training and patient counseling in lupus care.

Clinical photography of a scalp lesion demonstrates classic discoid lupus erythematosus (DLE) features. The image shows well-demarcated, erythematous to violaceous plaques with adherent scale, follicular plugging, and central atrophy within the hair-bearing scalp. Hair loss is patchy and the affected areas may progress to irreversible scarring alopecia. The margins are often raised and inflammatory, with surrounding pigmentary changes that may include hyperpigmentation or hypopigmentation depending on skin phototype. These cutaneous plaques are typically sun-exposed site–predilection lesions and may appear in chronic, fluctuating courses. Clinically, DLE must be distinguished from seborrheic dermatitis, tinea capitis, lichen planopilaris, and psoriasis; biopsy or dermoscopy can aid in confirmation. If biopsy is performed, histology reveals interface dermatitis with basal layer vacuolization, thickened basement membrane, perivascular and periadnexal lymphocytic infiltrate, and follicular plugging; mucin deposition may be present. Management involves photoprotection, topical or intralesional corticosteroids for active plaques, and systemic agents such as antimalarials in extending disease, with caution for systemic lupus erythematosus. This image is valuable for dermatology education, lesion recognition, differential diagnosis training, and AI-enabled image retrieval for cutaneous lupus and scarring alopecia research. Keywords: discoid lupus erythematosus, DLE, scalp lesions, scarring alopecia, autoimmune skin disease, hair loss. Clinical relevance includes guiding biopsy decisions and treatment planning.

Modality and view: In vivo dermoscopy (dermoscopy) of a discoid lupus erythematosus plaque on scalp skin, captured with noninvasive, magnified close‑up imaging. The primary lesion shows characteristic follicular plugging: round to oval keratin-filled openings that appear as yellow‑brown to tan plaques at the follicular ostia. Surrounding scale is minimal to moderate, with a subtle erythematous halo and fine perifollicular hyperkeratosis evident around plugged follicles. Hair shafts traverse the surface; there is no gross necrosis or ulceration in this field. The plugs are well circumscribed, sometimes surrounded by faint brown pigmentation, which may reflect chronic sun exposure and pigmentary alteration. These dermoscopic findings correlate with discoid lupus erythematosus histopathology, where follicular plugging and interface dermatitis are common. The presence of follicular plugs in a lupus-type plaque is highly suggestive and helps distinguish DLE from inflammatory dermatoses such as seborrheic dermatitis or eczema, where oiliness and scaling predominate without discrete keratotic ostial plugs. Diagnostic significance: dermoscopic follicular plugging supports clinical suspicion of DLE and guides biopsy targeting if confirmation is needed. Potential clinical uses include monitoring activity, treatment response, and differentiation from other scarring alopecias. In clinical practice, this image aids education of residents and researchers in recognizing DLE dermoscopic signatures on scalp skin.

A high resolution clinical photograph documents localized cutaneous discoid lupus erythematosus of sun exposed facial skin, notably the nasal dorsum and surrounding perinasal cheeks. The frontal, close up view shows well demarcated erythematous plaques with adherent whitish scale and crusting, surface desquamation, and subtle follicular plugging. Lesions appear on the nasal bridge with partial peripheral involvement, displaying an atrophic center and peripheral erythema; mild telangiectasia may be evident in chronically sun exposed areas. This morphologic pattern—oval or polygonal plaques with silvery scale and scarring tendency—aligns with classic discoid lupus as a chronic inflammatory dermatosis within the spectrum of cutaneous lupus erythematosus. Although biopsy is not provided here, typical histopathology would reveal epidermal atrophy, interface dermatitis, follicular plugging, dermal lymphocytic infiltrates, and increased dermal mucin if sampled. Clinically, the image underscores the risk of pigmentary change and scarring on the nose with ongoing disease activity. Relevance to practice includes differentiating discoid lupus from seborrheic dermatitis, rosacea, psoriasis, or actinic keratosis in sun exposed facial zones. Management implications involve sun avoidance, topical anti inflammatory therapies, calcineurin inhibitors, and consideration of systemic antimalarials for disease control, with regular monitoring for evolution or systemic involvement. This image is educational for clinicians, students, and researchers.

Clinical photography of a discoid lupus erythematosus lesion localized to the scalp/behind the ear demonstrates a solitary, well-demarcated erythematous plaque with adherent scale and thinning hair in the involved region. The plaque exhibits a raised red to violaceous border, a potentially atrophic center, and variable crusting, consistent with the classic morphology of DLE. Follicular plugging and surrounding erythema are common features, contributing to patchy hair loss (scarring alopecia) if chronic. The presentation is sun-exposed surface-limited, suggesting photosensitive cutaneous involvement. Imaging modality is non-invasive, relying on standard white-light clinical photography to document surface texture, scale, and border definition. Differential diagnoses include psoriasis of the scalp, tinea capitis, seborrheic dermatitis, cutaneous lupus erythematosus, lichen planus, and less likely basal cell carcinoma with ulceration on the scalp. Confirmation typically requires correlation with histopathology showing interface dermatitis with lymphocytic infiltrate and follicular involvement, and possibly direct immunofluorescence. Clinically, discoid lupus requires monitoring for progression to systemic lupus erythematosus, especially in patients with widespread disease or mucocutaneous involvement. Management emphasizes sun protection, avoidance of triggers, topical corticosteroids, calcineurin inhibitors, photoprotection, and, in selected cases, antimalarial therapy. This image is valuable for education on recognition, differentiation, and early diagnosis of discoid lupus erythematosus in dermatology training.