Background Hypertrophic cutaneous lupus erythematosus (HCLE), an uncommon variant of discoid lupus erythematosus (DLE), is a challenging diagnosis. Its clinical presentation as verrucous nodules or markedly hyperkeratotic plaques on the extensor surfaces of the extremities and/or the face, and accompanying histopathological features simulate squamous cell carcinomas and actinic keratoses.

Objectives We studied our collective experience of this rare entity over the past decade, to establish whether existing awareness of its challenging nature is sufficient to avert medical error.

Methods Patients with HCLE were identified via clinical records in Rheumatology and Dermatology and cross referenced with those in Pathology. Demographic, clinical and pathological data were reviewed.

Results Seven patients [2 men and 5 women] with HCLE were identified. The mean age was 49 years (range 30-61). In 4 patients with systemic lupus erythematosus (SLE), 3 had previously documented DLE and were under the care of a dermatologist and/or a rheumatologist. The remaining 3 patients were managed by plastic surgeons. The hyperkeratotic nodules and plaques of HCLE were located on the face in 4 cases and on the extremities in 3. Biopsies were undertaken in 5 cases because of a clinical suspicion of malignancy and in 2 due to diagnostic uncertainty. In 3 patients an erroneous clinical and pathological diagnosis was made prior to recognition of HCLE: 2 were diagnosed with squamous cell carcinomas in the perioral area resulting in inappropriate surgery; the other was diagnosed with psoriasis.

Conclusions In this series from an academic medical centre there was a failure to recognize and appropriately treat HCLE in 3 of 7 patients upon initial presentation. Despite cautionary evidence in the literature, HCLE continues to elude diagnosis, thereby leading to delayed medical intervention or inappropriate surgery.

Disclosure of Interest None declared

DOI 10.1136/annrheumdis-2014-eular.2260