History:

Patient of Dr 

44 year old lady 
diagnosed about 20 years ago with " Lupus" - I assume discoid type.
She reports some 6 months of sun sensitivity of her anterior chest and neck; if exposed, small blisters appear. she has been avoiding the sun.
About 2 weeks ago this annular ring on her neck appeared. Non- itchy.
She tried some steroid cream (triamcinolone) on it without any benefit.

A punch biopsy of the annular ring:
"The epidermis appears normal. There is a dense superficial and deep perivascular infiltrate of lymphocytes associated with increased amounts of dermal mucin. The differential includes erythema anulare centrifgum, a polymorphous light eruption and lymphocytic infiltrate of the skin ( Jessner) and tumid lupus erythematosus. In view of history, the latter seems most likely"

She is avoiding the sun already. The question is: is there any topical treatment which will help her?

A strong topical steroid cream such as diprosone plus sun protection should help. (Submitted By: Dr Ian McColl)