Posters

Chronic blepharitis revealing discoid lupus erythematosus: about two cases

Poster Details

First Author: R.Aymane MOROCCO

Co Author(s):    E. Alae   B. Yousra   B. Fatiha   B. Noureddine   C. Ouafaa        

Abstract Details

Purpose:

Discoid lupus erythematosus (DLE) is the most common form of chronic cutaneous lupus erythematosus (CCLE). Discoid lesions are often in the form of well-defined erythematous plaques with a thick adherent scale and follicular blockage. In old lesions, atrophic scars can be observed accompanied by warty hyperkeratosis. DLE generally affects the photo-exposed skin, most often the face. Lower eyelid damage occurs in 6% of patients; however, eyelid damage is rarely the only manifestation of DLE.

Setting:

Department A of ophtalmology, Hopital des spécialités,Mohamed V university, Rabat,Morocco

Methods:

A 56-year-old woman and a 39-year-old man presented in June 2006 and December 2018 for a red eye with redness of the left lower eyelid that persisted for one and two years. Both patients were treated for blepharitis with topical antibiotics and corticosteroids. Dermatological examination revealed an erythematous plaque with atrophy and adherent scales in the center, on the inner third of the lower left eyelid, quite similar in the 2 patients. The internal structures of the eye were not affected.

Results:

Immunoserological examinations showed positive anti-nuclear antibodies with a nucleolar pattern. Anti-SS-A (Ro) and anti-SS-B antibodies were negative. Histopathological analysis of the biopsy of the skin lesions showed typical characteristics of DLE: follicular hyperkeratosis, vacuolar degeneration of the basal cell layer and focal lymphocytic infiltrate in the dermis. Treatment included 250 mg chloroquine daily, 1% hydrocortisone ointment, and topical photoprotection. Discoid lesions completely resolved after four and eight weeks, respectively. The chloroquine treatment was continued for an additional eight weeks. The patients were examined every six months and no lesions had occurred for two years.Involvement of the eyelid only with ELD is rare and diagnosis can be difficult. The Donzis and their colleagues reported an average delay of two years before the correct diagnosis. Patients with these symptoms have generally been treated for blepharitis or suspected chronic eczema. DLE may be associated with other diseases of the eyelids, making it more difficult to recognize lupus lesions in a timely manner.

Conclusions:

The DLE of eyelid must be differentiated from the dysfunction of the Meibomian glands, sebaceous and basal cell carcinoma, lymphoma, psoriasis, seborrheic dermatitis, rosacea, sarcoidosis and contact dermatitis. Early recognition and treatment of the DLE eyelid is important to avoid eyelid dysfunction resulting from scarring, synechiae, trichiasis, entropion and ectropion. In addition, classic ELD patients in whom the eyelids are the only manifestation of the disease should be observed over a long period of time in order to identify recurrences and initiate treatment. In addition, the patient should be examined periodically for systemic involvement.

Financial Disclosure:

None