White, fibrous, papular lesions associated with systemic lupus erythematosus: is this an ongoing scar following vascular involvement?

A 20-year-old Japanese woman visited our hospital complaining of butter£y-like in¢ltrative erythema on her cheeks. She also complained of arthralgia and persistent slight fever. Physical examination revealed oedematous erythema on her upper back and pea-sized whitish macules and brownish nodules scattered on her upper limbs (Fig. 1a). Some of the lesions had an atrophic surface. Laboratory ¢ndings showed presence of LE cells, positive antinuclear antibody (6320, homogeneous and speckled), anti-DNA antibody (6160), anti-SS-A antibody (664), anti-cardiolipin IgG antibody (6.0 U/ml, normal; v1.0 U/ml), and decreased complement levels. Systemic investigation, including renal, pulmonary and cardiac function, revealed no involvement of the internal organs. Histological examination of the biopsy from the facial erythema showed liquid degeneration of the basal cells and mild perivascular in¢ltration of lymphocytes in the mid dermis, with linear deposition of IgG in the basement membrane by direct immuno£uorescence test. Histological examination of the atrophic macule showed slightly thickened collagen bundles in the deep dermis and colloidal iron staining showed partially positive mucin ¢ndings between collagen bundles, but no evidence of vasculitis (Fig. 1b).