A 22-Year Journey of Scalp Lupus: The Price of Delayed Care in Chronic Cutaneous Lupus Erythematosus
Location
Suwanee, GA
Start Date
6-5-2025 1:00 PM
End Date
6-5-2025 4:00 PM
Description
Background:
Discoid lupus erythematosus (DLE) is a relentless autoimmune disease that, when affecting the scalp, can lead to permanent, disfiguring scarring alopecia. Despite its potential for early intervention, many cases go undiagnosed or undertreated, leaving patients with irreversible damage. This case follows a 22-year trajectory of progressive scalp DLE, illustrating the consequences of delayed care and the challenge of managing chronic cutaneous lupus.
Case Presentation:
A 67-year-old woman presented with severe scalp itching, persistent hair loss, and scarring. She was first diagnosed with scalp DLE 22 years ago after months of unresponsive treatment. A biopsy at the time confirmed characteristic findings: hyperkeratosis, follicular plugging, vacuolar interface dermatitis, and thickened basement membrane. Despite an initial diagnosis, life circumstances took priority over treatment, leading to years of disease progression without adequate management.
Now, two decades later, she returns with widespread scalp plaques, cicatricial alopecia, and active inflammation, highlighting the irreversible nature of untreated DLE. A repeat biopsy reaffirmed active disease with ongoing inflammation, and she was restarted on intralesional corticosteroids, hydroxychloroquine, and high-potency topical therapy.
Discussion:
This case highlights a critical gap in long-term autoimmune disease management—the cost of delayed dermatologic follow-up. Scalp DLE mimics other inflammatory conditions such as lichen planopilaris and psoriasis, making early diagnosis essential. Once scarring sets in, hair regrowth is no longer possible, underscoring the urgency of early biopsy, systemic therapy, and patient adherence.
Conclusion:
DLE is not just a dermatologic condition—it is a lifelong battle. This case demonstrates the devastating consequences of disease neglect, reinforcing the need for aggressive early intervention, routine follow-up, and patient education. With emerging treatments such as JAK inhibitors and biologics, there is hope for better long-term outcomes in preventing the progression to irreversible alopecia.
Embargo Period
5-28-2025
Included in
A 22-Year Journey of Scalp Lupus: The Price of Delayed Care in Chronic Cutaneous Lupus Erythematosus
Suwanee, GA
Background:
Discoid lupus erythematosus (DLE) is a relentless autoimmune disease that, when affecting the scalp, can lead to permanent, disfiguring scarring alopecia. Despite its potential for early intervention, many cases go undiagnosed or undertreated, leaving patients with irreversible damage. This case follows a 22-year trajectory of progressive scalp DLE, illustrating the consequences of delayed care and the challenge of managing chronic cutaneous lupus.
Case Presentation:
A 67-year-old woman presented with severe scalp itching, persistent hair loss, and scarring. She was first diagnosed with scalp DLE 22 years ago after months of unresponsive treatment. A biopsy at the time confirmed characteristic findings: hyperkeratosis, follicular plugging, vacuolar interface dermatitis, and thickened basement membrane. Despite an initial diagnosis, life circumstances took priority over treatment, leading to years of disease progression without adequate management.
Now, two decades later, she returns with widespread scalp plaques, cicatricial alopecia, and active inflammation, highlighting the irreversible nature of untreated DLE. A repeat biopsy reaffirmed active disease with ongoing inflammation, and she was restarted on intralesional corticosteroids, hydroxychloroquine, and high-potency topical therapy.
Discussion:
This case highlights a critical gap in long-term autoimmune disease management—the cost of delayed dermatologic follow-up. Scalp DLE mimics other inflammatory conditions such as lichen planopilaris and psoriasis, making early diagnosis essential. Once scarring sets in, hair regrowth is no longer possible, underscoring the urgency of early biopsy, systemic therapy, and patient adherence.
Conclusion:
DLE is not just a dermatologic condition—it is a lifelong battle. This case demonstrates the devastating consequences of disease neglect, reinforcing the need for aggressive early intervention, routine follow-up, and patient education. With emerging treatments such as JAK inhibitors and biologics, there is hope for better long-term outcomes in preventing the progression to irreversible alopecia.