A 26-year-old African American woman was concerned about the gradual onset of mildly tender, but severely distressing facial lesions. She had not sought medical attention previously because of a lack of insurance and assurances by her mother that this was only “bad acne.” Use of a popular over-the-counter benzoyl peroxide–based acne kit brought no improvement.
Key point: While acne can lead to scarring and to post-inflammatory dyschromia, the degree of such alteration is unusual. In fact, scarring and dyschromia are also hallmarks of discoid lupus erythematosus. A biopsy confirmed this diagnosis.
Treatment: The patient was treated with oral antimalarial medication (hydroxychloroquine) and a low-potency retinoid. New lesions ceased to appear and older ones improved.
Note: This case highlights how closely features of widely disparate skin disorders can mimic one another. Obtaining histologic results from a representative biopsy is always a good idea before embarking on extensive therapy.