Unveiling Multiple Chronic Relapsing Plaques and Ulcerations in a Healthy Individual

Lupus erythematosus panniculitis is an uncommon variant of chronic cutaneous lupus erythematosus. The lesions are characterized by the involvement of subcutaneous tissue, typically presented with tender erythematous or purplish subcutaneous nodules or plaques with different overlying skin appearances, rarely skin ulceration. The clinical course of LEP is typically chronic and relapsing with periods of exacerbations which can be triggered by trauma. Most LEP patients have a favorable prognosis in SLE patients. We report a 60-year-old Southeast Asian female who presented with reddish ulcerated plaques on the face and left arm for 2 months. Histopathological findings showed peri-adnexal and subcutaneous fat lobule inflammation consisted of lymphocytes, plasma cells, and some histiocytes. Focal hyaline necrosis of fat cells was also identified. Although DIF tests showed negative results, CD123+ immunohistochemical staining was found positive. Other blood investigations were unremarkable. She did not fulfill the criteria for systemic lupus erythematosus. She was successfully treated with hydroxychloroquine, oral prednisolone, and a topical potent corticosteroid. The patient clinically improved within a few months with hyperpigmentation.