Could my cheek spot be lupus, or is it due to sun damage?

Question

Hello doctor,

I have had a spot on my skin for about two weeks, and it is not healing. It started out like a pimple and is now spreading. I thought it was an infected pimple and applied Bactroban, which did not help. It tingles and burns. I do not know whether it is a fungal infection or not.

I had something similar to that last year, and that took a long time to heal as well. It healed and left a dark mark on my face, as seen in the picture. I had a blood test done, and everything came back normal. I am taking multivitamins, vitamin D, and B12 now. The spot is bothering me because I am very fair, and it is right on my cheek.

Please help.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

I went through your images (the attachments removed to protect the patient's identity). Since you are a very fair-skinned patient, you are naturally more exposed to sun radiation, which is UV-A and UV-B (ultraviolet A and B) rays. In effect, what it does is disrupt the self-healing power of your skin and make you more vulnerable to sun damage.

The damage accumulates over time, and the net result is skin changes along with the symptoms you described in your questionnaire. Microscopically, the cells in the deepest layers undergo irreversible changes, and the cellular environment becomes a very rampant scenario where the speed to clear the damaged cells falls short of the rate at which the cells are damaged.

So, it results in pigmentation, slow or non-healing, and damage at the molecular level. In my professional opinion, gauging from the picture alone, my diagnosis goes in favor of discoid lupus erythematosus or DLE. It is a chronic or longstanding skin response to sun damage.

It is a reversible benign condition if we institute the treatment right away. However, if we leave it to change, letting time be the healer, it can transform itself into a more severe form of skin condition. It would include wearing good sunscreen like SPF 50 (sun protection factor) or SPF 70 with PA+++ on a daily basis. It should be applied liberally on all the sun-exposed sites of the body, like arms, face, neck, etc.

You must apply it 15-20 minutes before going outdoors. It should be reapplied again after 2-3 hours. If the face becomes oily, it is a good idea to cleanse the face with a face wash and then reapply the sunblock.

My advice is to visit your dermatologist and take a skin biopsy to analyze the edges and the cell changes to clinch the perfect diagnosis. A biopsy is the definitive diagnosis. The treatment option is adequate sun protection. You can use a mid-potent steroid cream like Mometasone on the affected part every night for 12-14 days, and you can see a dramatic improvement. Avoid the sun at all costs. Use a cloth to cover the area when you go outside.

Strict sun protection is the cornerstone of the treatment. Try eating more beta-carotene in your diet from sources like carrots, which act as natural sunscreens.

Hope it helps.

Thank you.