Bowen's is SCC in situ and presents as a scaly plaque, but it lacks the key DLE features of follicular plugging, dermal atrophy, and a preference for the head and neck.
This presents as a soft, brownish-red plaque on the face, but it lacks the prominent scale and follicular plugging of DLE and has a distinct histology.
A kerion is an intense, boggy, inflammatory reaction to a fungal infection (tinea), which is a suppurative and acute process, unlike the chronic, atrophic plaque of DLE.
LPP is a primary scarring alopecia, and while it can be confused with scalp DLE, it is distinguished by more prominent perifollicular erythema and the absence of DLE lesions on non-hair-bearing skin.
Hypertrophic LP can form thick plaques, but they are typically violaceous and intensely itchy, whereas DLE plaques are more erythematous and lead to more significant atrophy.
This is a form of cutaneous tuberculosis, presenting as a reddish-brown plaque that has a characteristic "apple-jelly" color on diascopy (pressing with a glass slide).
This benign B-cell proliferation presents as a solitary, reddish, fleshy nodule or plaque, lacking the surface scale, atrophy, and follicular plugging of DLE.
Morphea is a sclerotic (hardened) plaque, which feels firm and bound-down, whereas a DLE plaque is primarily inflammatory and atrophic, not fibrotic.
Psoriasis is distinguished by its thick, silvery scale and lack of underlying atrophy or follicular plugging; removing the scale reveals pinpoint bleeding (Auspitz sign).
While causing facial erythema, rosacea is characterized by papules, pustules, and flushing, and lacks the adherent scale and scarring potential of DLE.
Cutaneous sarcoidosis presents as reddish-brown papules or plaques that show "apple-jelly" nodules on diascopy and are confirmed by a biopsy showing non-caseating granulomas.
Tinea faciei is a fungal infection with an active, scaling border that responds to antifungals and is confirmed by a KOH test, unlike the autoimmune plaque of DLE.
