Clinical and trichoscopic features of scalp discoid lupus erythematosus in skin of colour: A retrospective analysis

Background Discoid lupus erythematosus (DLE) on the scalp can be confused with various scarring alopecias. There is no large-scale trichoscopic study on scalp DLE, and the trichoscopic features in skin of colour are underreported. Objective This study aimed to analyse the clinical and trichoscopic features of DLE on the scalp in skin of colour. Methods This retrospective cross-sectional study analysed the clinical and trichoscopic images of all the biopsy and direct immunofluorescence-proven cases of scalp DLE. Results The prevalent trichoscopic features encompassed follicular, perifollicular, and interfollicular findings. Follicular features included follicular plugs (87%) and yellow dots (53%). Perifollicular findings comprised white scales (92%), white (94%) and brown structureless areas (87%), shiny white structures (SWSs; 75%), and erythema (74%). Interfollicular features included white to pinkish-white structureless areas (90%), white scales (88%), brown structureless areas (81%), shiny white structures (75%), and erythema (72%). Vascular patterns observed were linear irregular, linear, arborising, and polymorphous vessels. Limitations The study's limitations were small sample size, and a retrospective design. Conclusion Scalp DLE presents as two distinct clinical morphologies in skin of colour, and the trichoscopic features can vary depending on the clinical morphology.