Treatment of discoid lupus erythematosus with crisaborole.
Yingying Dai, Deyu Song, Hongjie Liu et al.
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Case in brief
A 20-year-old woman had a persistent erythematous nasal plaque for seven years that had been misdiagnosed and had not responded to multiple systemic and topical treatments, including antimalarials. Histopathology and direct immunofluorescence supported discoid lupus erythematosus (DLE), with no systemic involvement. She received topical crisaborole 2% once daily alongside hydroxychloroquine. Marked improvement was seen after two months, followed by remission through seven months of follow-up while crisaborole continued and hydroxychloroquine was reduced. No recurrence or adverse effects were reported.
What made this case unusual
The report describes facial DLE responding to crisaborole, a topical phosphodiesterase-4 inhibitor approved for atopic dermatitis, after the lesion had been refractory to multiple treatments.
Diagnostic / clinical pearl
For a persistent facial plaque that has been misdiagnosed or resists treatment, histopathology and direct immunofluorescence can support DLE diagnosis; this case also documents improvement with crisaborole used alongside hydroxychloroquine.
Why it matters
The response suggests crisaborole may be a nonsteroidal option for facial DLE, but further studies are needed to establish its efficacy and long-term safety.