A 46-year-old woman presented with 7 years history of depressed lesion just above the left side of mouth. It was asymptomatic. She has seen few dermatologists and a plastic surgeon but none really helped her lesion. She did not have polyarthalgia or other constitutional symptoms. Drug history was nil significance.
Examination showed 2 areas of depression, almost tethered to the underlying dermis just above the left side of the mouth and another a bit above the angle of mouth. There is no induration on deep palpation. The inner buccal mucosa appeared normal.
Serology for lupus including ANA, anti Ro, Anti La, and other extractable nuclear antigens were negative. Possible diagnoses would include lupus profundus and morphoea. Biopsy with immunofluorescence studies should help. Anyone has any therapeutic pearls for this lady??
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