{'fraction_non_alphanumeric': 0.02271907681211684, 'fraction_numerical': 0.005409304002884962, 'mean_word_length': 5.233707865168539, 'pattern_counts': {'":': 0, '<': 0, '<?xml version=': 0, '>': 0, 'https://': 0, 'lorem ipsum': 0, 'www.': 0, 'xml': 0}, 'pii_count': 0, 'substrings_counts': 0, 'word_list_counts': {'cursed_substrings.json': 0, 'profanity_word_list.json': 0, 'sexual_word_list.json': 0, 'zh_pornsignals.json': 0}}
A case of discoid lupus erythematosus masquerading as acne.

175 Letters to the Editor Sir, We describe here a case of discoid lupus erythemato-sus (DLE) masquerading as acne vulgaris. Cutaneous manifestations of lupus erythematosus (LE) are usually characteristic enough to permit straightforward diagnosis. However, occasionally they may be variable and mimic other dermatological conditions. Acneiform presentation is one of the most rarely reported and one of the most confusing, as it resembles a very common inflammatory skin disease and therefore can be easily missed clinically. Only 5 cases have been reported in the literature (1–4). The patient described here presented with a widespread pruritic acneiform rash, which was initially diagnosed and treated as acne vulgaris with no response. Subsequently, when the diagnosis of DLE was established, the patient was treated with hydroxychloroquine and showed complete response. This case illustrates that it is important to consider LE in patients who present with an acneiform rash who fail to respond to conventional acne treatment. CASE REpORT A 38-year-old man from Afghanistan presented with a 7-year history of a pruritic and photo-aggravated rash affecting his face, chest and back. He was otherwise well apart from intermittent neck pain following an injury 2 years previously, but had recently also developed backache and arthralgia of his left shoulder. His only medication was a non-steroidal anti-inflam-matory drug (NSAID). On examination he had a widespread acneiform eruption, which was distributed on his face, pre-sternal area and back, particularly down the length of his spine. He had multiple brown-red follicular papules and open comedones, especially on his back, and hypopigmented atrophic scars. There were no pustules or nodulocystic lesions (Fig. 1). Treatment was started with erythromycin 500 mg bid and adapalene cream once daily to treat a presumed diagnosis of acne vulgaris. He was seen 3 months later with a deterioration of his clinical appearance and increased pruritus. This was attributed by the patient to increased sun exposure. The photo-aggravation, the intense pruritus and the absence of pustules and nodulocystic lesions broadened our differential diagnosis and therefore diagnostic biopsies were obtained. A biopsy from the back where the rash was most suggestive clinically of acne vulgaris, showed hyperkeratosis with orthokeratosis, epidermal atrophy and extensive vacuolar degeneration of the basal layer of the epidermis. There was also prominent interface dermatitis, accumulation of cytoid bodies and plugging of the follicles by keratin and deep periadnexal and pericapillary chronic inflammation. These findings were consistent with a diagnosis of DLE. Facial …