Discoid Lupus Erythematosus Presenting with Cysts, Comedones, and Cicatricial Alopecia on the Scalp

A 33-year-old female with East Indian descent presented with patchy hair loss and DLE lesions on her face and scalp. Despite initial treatments with hydroxychloroquine, intralesional triamcinolone, and topical betamethasone, her scalp lesions progressed, showing cicatricial alopecia with cysts and comedones. Subsequent treatments included oral isotretinoin, which the patient refused, and a combination of intralesional triamcinolone, clobetasol lotion, and mechanical extraction of comedones, leading to stabilization of the lesions. Histologic findings from an excisional biopsy revealed benign epithelial inclusion cysts and comedones without active lupus erythematosus, suggesting these features might be secondary changes from the scarring process.