Lupus Diagnosis and Type?

[Pentar]

I was just diagnosed with non-systemic Lupus and been given a prescription for Plaquenil. My question is in regards to the type of Lupus. The ICD9 code written is 695.4, which is listed as Lupus: erythematodes (discoid) and Lupus: erythematosus (discoid), not disseminated. I was trying to research this online and found a site for the different types of cutaneous lupus erythematosus (with pictures). Discoid, to me, appears more as rash. What I have appears to be Lupus Profundus, based on visual observation.

The site I am referring to above is http://dermnetnz.org/immune/cutaneous-lupus.html (It has some pretty pictures for reference). Listed below are links to photos of the soft painful "holes" that has been led to this diagnosis.

http://s822.photobucket.com/albums/zz145/Pentar/?action=view&current=100_0071.jpg

http://s822.photobucket.com/albums/zz145/Pentar/?action=view&current=Hole1.jpg

http://s822.photobucket.com/albums/zz145/Pentar/?action=view&current=100_0055.jpg

Also for reference below it the result of the biospy:

"There is exudation into the stratum corneum with loss of epidermal integrity and with both acute and chronic inflammation. There is no demonstrable atrophoderma, and the features suggest excoriation. There is an inflammatory process in the dermis that lacks eosinophilia and the is no granuloma. There is no evidence of neoplasia in the material submitted."

So, basically I am wondering what type of Lupus I have. Is is Discoid or Profundus? Or is Profundus just part of Discoid for the ICD9 coding?

Any help is greatly appreciated. Thank you.

[Pentar]

I thought it interesting as well, and would have welcomed a second biopsy to for complete confirmed. The idea that the first biopsy was "too superficial" and instead we are going with the histopath seemed a little puzzling.

[maatson]

I was just wondering how a visible area of atrophy is not seen under microscopy.But since the histopath was otherwise one had to settle to the results. Indeed the biopsy was more superficial than the atrophy.
Interesting indeed.Best wishes for speedy recovery. M.

[Pentar]

Thank you for your reply. I spoke with my dermopathologist to get clarification on the matter. He said that he suspects degeneration of subcutaneous fat after reviewing the biopsy slide, and has considered another biopsy - as he believes the degeneration is deeper than where the first biopsy shows. He has decided against another biopsy at this time and for now I am to just begin treatment with Plaquenil and Locoid Lipocream. I go in for the eye exam tomorrow, and then I can start the Plaquenil.

[maatson]

Despite the clinical picture suggesting of panniculitis, the histopathologic feature show no evidence of lobular hyaline degeneration of subcutaneous fat, which is the main feature of LE Profundus.
Thus the diagnosis of Discoid LE stays, and then Discoid LE on the scalp can present atypical with focal alopecia.
Best wishes.