A 45 year old woman had a history of Systemic Lupus Erythematosus onset at the age of 34 with Raynaud's phenomenon, arthralgia, arthritis, fever and malar rash. She had high antinuclear autoantibody titers on HEp-2 cells, nRNP, Sm, and anticardiolipin IgG antibodies.
The malar dermatitis evolved to a CCLE plaque with prominent scaling. Further discoid lesions appeared on the scalp, ears, trunk, upper extremities and hands, on both dorsal and palmar surface despite topical steroids, antimalarials and prednisone therapy.
Various SLE manifestations may show a different response to therapy: the steroid doses used to control this patient's arthritis did not improve the skin lesions.