Dermatology 2026

Background: Subacute cutaneous lupus erythematosus (SCLE) is a photosensitive, non-scarring form of cutaneous lupus characterized by annular or papulosquamous lesions. Diagnosis may be particularly challenging in patients with advanced human immunodeficiency virus (HIV) infection because immune dysregulation, opportunistic infections, and medications can produce overlapping clinical and histopathologic findings.

Case: A 24-year-old man with newly diagnosed HIV/AIDS and a CD4 count below 5 cells/µL presented with a six-week history of a generalized, non-pruritic papulosquamous eruption. Lesions initially involved the malar region with sparing of the nasolabial folds and subsequently spread to the scalp, face, trunk, extremities, palms, and soles. Alopecia universalis, 20-nail dystrophy, and oral candidiasis were also present. Skin biopsy demonstrated compact orthokeratosis, vacuolar interface alteration, focal basement membrane thickening, superficial and deep perivascular and periadnexal lymphohistiocytic infiltrates, and increased interstitial dermal mucin, supporting SCLE in the appropriate clinical context. Despite these findings, antinuclear antibody and anti-double-stranded DNA antibodies were negative, with preserved complement levels. The patient also had Coombs-positive hemolytic anemia, marked transaminitis, and splenomegaly. Infectious mimickers, including syphilis, tuberculosis, and fungal infection, were excluded. Treatment with topical corticosteroids, photoprotection, emollients, antifungal therapy, antiretroviral therapy, antimicrobial prophylaxis, and a limited course of systemic corticosteroids resulted in significant clinical improvement.

Conclusion: This case highlights the diagnostic complexity of SCLE in profound HIV-associated immunosuppression. Negative lupus serology should be interpreted cautiously and does not replace clinicopathologic correlation. Concomitant alopecia universalis and 20-nail dystrophy suggest broader immune dysregulation, while prolonged cotrimoxazole exposure raises the possibility of drug-induced SCLE. Multidisciplinary management and longitudinal follow-up are essential.

Dr. Jeanne Kaye D. Sacliwan has completed her medical degree from Saint Paul University Philippines, Tuguegarao. She is currently a 2^nd year resident of the Department of dermatology and venereology at Southern Isabela Medical Center. She had published 1 case report under Asian Journal of Pediatric Dermatology entitled “A Colloidon baby with a Lamellar Phenotype:ABCA12-related Autosomal Recessive Lamellar Ichthyosis”.