we present clinically peculiar facial discoid lupus erythematosus ( dle ) that mimicked tinea faciei , cutaneous granulomatous disease and blepharitis . although dle is a chronic autoimmune dermatosis , it has a variety of rare clinical presentations , including periorbital dle , comedonic dle   and hypertrophic dle   recently . in this case , a scaly , erythematous lesion on the eyelid mimicked blepharitis . moreover , the central healed , mildly elevated , annularly distributed facial dle confused tinea faciei or granulomatous cutaneous disease . since a case of tinea faciei coexisting with dle had previously been reported , this complicated our diagnosis . a 39-year - old japanese man first noticed erythema on his right eyelid and right cheek in 2010 . he received medical treatment ( topical hydrocortisone butyrate propionate ) at a local dermatological clinic . however , his symptoms did not improve , and laboratory testing at the neighborhood clinic revealed no abnormal findings . therefore , he visited our hospital in 2012 to obtain a clinical examination and diagnosis for his cutaneous disease . clinical examination from the frontal view revealed eruptions on his bilateral inner and upper eyelids . the main signs of disease were well - demarcated , mildly elevated , dark - red erythemas with pityriasis scales , and keratotic papules as well as pustules were also seen ( fig . 1 ) . in addition , swelling around the eyelids was visible , and these eyelid symptoms appeared to indicate blepharoconjunctivitis or allergic dermatitis . in addition , there were linearly distributed erythemas with lamellar scales , 1-cm dark - red erythemas with pityri - atic scales and cutaneous very mild atrophy on the right side of his face . these eruptions had coalesced into one large annular , mildly elevated eruption , and pigmentation was vis - ible at the center of the annular eruption , although no scales and erythemas were noticeable ( fig . 2 ) . there also appeared to be central healing and peripheral elevation as is observed in cases of tinea faciei or granulomas , especially granuloma trichophyticum , sarcoidosis and annular elastolytic giant cell granuloma . hyphae were not observed after potassium hydroxide extraction , and his neck and cervical lymph nodes were not palpable . based on these findings , laboratory testing was performed , and a complete blood count revealed that his white blood cell count was slightly decreased to 2,180/ml ( normal 3,0007,800 ) . his antinuclear antibody titers were slightly elevated to 40 u ( normal < 40 ) . apart from that , the following laboratory results were normal : hemoglobin 10.5 g / dl ( normal 10.414.4 ) , total protein 7.2 g / dl ( normal 6.58.0 ) , and albumin 4.7 g / dl ( normal 4.05.2 ) . his c - reactive protein level was 0.08 mg / dl ( normal < 0.5 ) , and the results of tests for anti - double - strand dna antigen , anti - ssa antigen , anti - ssb antigen and human immunodeficiency viral antibodies were also negative . therefore , we performed a skin biopsy of his right cheek , and cutaneous histopathological analysis with hematoxylin and eosin staining revealed parakeratosis and hyperkeratosis of the horny layer . however , in the dermis , typical dense lymphoid cells were observed around the follicles and eccrine glands ( fig . mucin depositions were observed in the dermal stroma , and periodic acid - schiff stain revealed that the basement membranes were thicker than those in normal skin . a direct immunofluorescence histopathology test revealed igg deposition on the basement membrane zone and perifollicular areas ( not shown ) . from the lateral view , our case was clinically characterized by facial dle that originally appeared to be tinea faciei or granulomatous cutaneous disease ( fig . only one case of coexisting dle and tinea faciei   and two cases of tinea faciei mimicking lupus erythematosus have been reported [ 6 , 7 ] . a previous report also showed that dle confused sarcoidosis , granuloma annulare and granuloma faciale . 1 ) , and the eyelid dle appeared to be blepharitis or allergic dermatitis . however , eyelid involvement is rare for dle ( only 6% of cases ) , and it is typically accompanied by other cutaneous eruptions . .   stated that the diagnosis of eyelid dle can be significantly delayed due to difficulty in obtaining histopathology samples . dle has various uncommon subtypes [ 1 , 2 , 3 , 4 , 5 ] , although the causes of these peculiar dle subtypes are not clear . the symptoms of facial dle may mimic tinea faciei [ 6 , 7 ] and other granulomatous cutaneous diseases . the patient 's mild facial atrophy was explained by this histopathology , and showed like tinea faciei . additionally , the dermal severe dense lymphoid cell infiltrate around appendage might show partial mild elevation , resulted in granulomatous clinical appearance . these eruptions coalesced into one large annular , mildly elevated erythema also might mimic annular granulomatous appearance . our case reinforces the importance of considering the various clinical presentations of dle , and dermatologists should be aware of these presentations , especially in cases with facial eruptions .
we present clinically peculiar facial discoid lupus erythematosus ( dle ) that mimicked tinea faciei . 
 although dle is a chronic autoimmune dermatosis , it has a variety of rare clinical presentations , including periorbital dle , comedonic dle and hypertrophic dle recently . in this case , 
 a scaly , erythematous lesion on the eyelid and the central healed , mildly elevated , annularly distributed facial dle mimicked tinea faciei , complicating our diagnosis .