Successful treatment of generalized discoid lupus erythematosus with imiquimod cream 5%: a case report and review of the literature.

Discoid lupus erythematosus (DLE) is the most common form of chronic cutaneous lupus erythematosus. It tends to heal with scarring, hair loss, and pigmentary changes if treatment is not initiated in the early phase of the disease. Classic DLE lesions are initially red-purple macules, papules, or small plaques that rapidly acquire a hyperkeratotic appearance. Only a minority of patients with DLE progress to develop systemic lupus erythematosus (SLE). A small percentage of patients with SLE have concomitant DLE. However, generalized DLE is more frequently associated with systemic involvement than classic DLE. The diagnosis of DLE is usually based on clinical features, although in some cases histopathological examination may be required to confirm the diagnosis. Standard therapy for cutaneous lupus erythematosus includes broad-spectrum sunscreens, topical and intralesional glucocorticoids, and antimalarial agents. A 63-year-old man presented with erythematous scaly patches that he had on the face for approximately eight months. Although the face was the main affected site, lesions were also noted on the scalp, neck, chest, shoulder, upper arms, and trunk. Histopathological examination verified the diagnosis of DLE. Laboratory examination and consultation with other departments did not reveal any systemic involvement. Imiquimod cream 5% was applied three times a week, every other week. After 24 applications over a period of two months, an almost complete recovery was achieved. Topical imiquimod may be an alternative treatment for generalized DLE.