Blue-White Veil as Novel Dermatoscopic Feature in Discoid Lupus Erythematosus in 2 African-American Patients

Dermoscopic features of discoid lupus erythematosus (DLE) depend on the stage of the lesions: active lesions include yellow-brown dots and red dots, whereas longstanding inactive lesions show absence of follicular openings, cicatricial milky red or white patches, structureless white and brown areas, and thick arborizing vessels. Loss of pinpoint white dots, blue-gray dots in a speckled pattern, and a peripheral pigmented network have been described on dermoscopy of DLE in dark skin. We report a blue-white veil as a novel dermoscopic feature in 2 cases of biopsy-proven DLE in African-American patients. Dry trichoscopy revealed a central white area surrounded by irregular patchy areas of confluent blue and brown pigment and an overlying white "ground-glass" hue. This corresponds on pathology to the hyperkeratosis overlying interface changes at the dermal-epidermal junction, with pigment incontinence and melanophages in the papillary dermis.