Xanthomatous Reactions in Cutaneous Lupus Erythematosus—More Than an Incidental Finding?

Cutaneous lupus erythematosus (CLE) is a well-known autoimmune disorder within dermatology. However, findings of lipid-laden macrophages and xanthomas in a subset of these cases are less understood and usually labeled as a rare, incidental finding. For this reason, a very limited amount of literature has been published regarding the phenomenon. We reviewed 84 cases diagnosed as CLE from 2022 to 2024 from our dermatopathology laboratory. Of the 84 cases of CLE, 9 (11%) demonstrated xanthomatous changes, with 67% sub-classified as discoid lupus and 33% as lupus panniculitis. CLE with xanthomatous reactions may be more common than once thought, as our sampling revealed a prevalence of 11%. Further studies are needed to investigate prevalence as well as possible clinical correlations, as these could influence diagnosis, prognosis, and treatment for this subset of cases.