| Abstract (croatian) | Cilj: Prikazati slučaj pacijentice s komedonalnim lupusom – izuzetno rijetkim oblikom kroničnog kutanog eritemskog lupusa (engl. chronic cutaneous lupus erythematosus; CCLE). Naglasak je stavljen na specifičnosti kliničke prezentacije i dijagnostičke izazove koji prate ovu bolest. Prikaz slučaja: 37-godišnja pacijentica zaprimljena je u dermatološku ambulantu zbog pojave eritematozne infiltracije na lijevoj strani brade, uz prisutnost otvorenih komedona te atrofičnih ožiljaka i tamnijih komedona periaurikularno. Inicijalno je postavljena dijagnoza subakutnog apscesa brade te je pacijentici propisana antibiotska terapija i planirano daljnje kirurško liječenje, no promjena u izgledu lezije potaknula je sumnju u inicijalnu radnu dijagnozu. Stoga je učinjena incizijska biopsija lezije te je korelacijom kliničke slike, patohistološkog nalaza i rezultata naknadne laboratorijske obrade utvrđeno da pacijentica ima komedonalnu varijantu CCLE-a. Propisana joj je terapija hidroksiklorokinom uz intralezionalnu primjenu triamcinolona. Nakon pojave makularnih promjena terapija hidroksiklorokinom je ukinuta te je uveden metotreksat. Tri mjeseca kasnije doza metotreksata povećana je zbog peristentnog eritema i edema lezije te je intenzivirana terapija intralezionalnim triamcinolonom, što je u periodu od šest mjeseci rezultiralo poboljšanjem kliničke slike. Zaključak: Komedonalni lupus iznimno je rijedak podtip CCLE-a. Do danas ovo je 20. opisani slučaj koji ukazuje na izazove u dijagnostici i terapiji zbog nedostatka tipičnih dermatoloških obilježja i neizvjesnosti prognoze. Patohistološka analiza i korelacija s kliničkom slikom ključne su u potvrdi dijagnoze. Bitna je važnost pravovremenog postavljanja dijagnoze uz individualiziran terapijski pristup te kontinuirano praćenje bolesnika radi mogućnosti progresije u sistemski oblik bolesti. |
| Abstract (english) | Aim: To present a case of a patient with comedonal lupus, an exceptionally rare form of chronic cutaneous lupus erythematosus (CCLE). Emphasis is placed on the clinical presentation and diagnostic challenges associated with this condition. Case report: A 37-year-old woman presented to the dermatology clinic with an erythematous infiltration localized on the left side of her chin, accompanied by open comedones. Additionally, periauricular atrophic scarring and darker comedones were noted. Initially, a diagnosis of a subacute abscess was made, and the patient was prescribed antibiotic therapy with planned further surgical treatment. However, a change in the lesion’s appearance prompted suspicion of the initial diagnosis, resulting in an incisional biopsy. After correlating clinical presentation, histopathological findings, and laboratory results, the patient was diagnosed with the comedonal variant of CCLE. Treatment with hydroxychloroquine, along with intralesional injection of triamcinolone, was initiated. After the onset of macular changes, hydroxychloroquine was replaced with methotrexate. Three months later, the dose of methotrexate was increased due to persistent erythema and edema of the lesion, and intralesional triamcinolone therapy was intensified, resulting in improvement of the clinical picture over six months. Conclusion: Comedonal lupus is an extremely rare subtype of CCLE. This report represents the 20th documented case, highlighting the diagnostic and therapeutic challenges due to the lack of typical dermatological features and uncertainty of prognosis. Histopathological analysis and correlation with the clinical presentation are crucial for confirming the diagnosis. Timely diagnosis is essential, along with an individualized therapeutic approach and continuous patient monitoring for the possibility of progression to systemic disease. |
