Background and design: The possible distinction between different types of cutaneous lupus erythematosus (CLE) based on histologic features has been largely debated. This study describes the histopathologic features of three distinct subsets of CLE: chronic, annular-subacute, and papulosquamous-subacute. Biopsy specimens from 92 patients with CLE were examined without the clinical diagnosis being known by the examiners. Of them, 36 clinically demonstrated chronic CLE; 32, annular-subacute CLE; and 24, papulosquamous-subacute CLE.
Results: In chronic CLE, the dermal changes (basement membrane thickening, dermal colloid bodies, pilosebaceous atrophy, and periappendageal infiltrate) were more frequent, while in annular-subacute CLE, a more severe vacuolation of the basal layer and a greater number of epidermal colloid bodies were seen. In addition, pilosebaceous atrophy and more severe epidermal damage were almost exclusive to chronic CLE and annular-subacute CLE, respectively.
Conclusions: Although some histologic differences between chronic and annular-subacute CLE exist, histopathologic diagnosis of the CLE subsets can only be accurately established when pilosebaceous atrophy or necrosis of all epidermal layers is observed.