OSCE — photosensitive plaques and scarring alopecia: cutaneous lupus classification and first-line therapy

Brief (to candidate)

A 34-year-old woman has annular polycyclic scaly plaques on the upper back and arms after sun exposure, mild arthralgia, and positive anti-Ro/SSA. She is considering pregnancy. A separate patient photo shows scarring discoid plaques on the scalp. You have 8 minutes to classify CLE, investigate for SLE, and manage including pregnancy counselling.

Candidate instructions

1. Classify ACLE vs SCLE vs DLE (CCLE).
2. Plan labs for systemic involvement.
3. State first-line photoprotection + antimalarial therapy and monitoring.
4. Identify drug-induced SCLE culprits.
5. Counsel anti-Ro pregnancy risk (neonatal lupus/CHB).
6. Address scarring alopecia urgency in DLE.

Examiner checklist (mark each domain / 10)

Model key actions

• Diagnose SCLE phenotype with anti-Ro and screen for SLE organ involvement.^[1][2]
• Start photoprotection + hydroxychloroquine with retinal monitoring; stop drug triggers if present.^[4][7]
• Counsel pregnancy/anti-Ro risks and co-manage; treat DLE aggressively to limit scarring.^[10]

Common errors

• Using high-potency topical steroids alone long-term without antimalarials/photoprotection.
• Missing urinalysis/systemic work-up.
• No retinal screening plan on hydroxychloroquine.
• Ignoring drug-induced SCLE.
• Inadequate anti-Ro pregnancy counselling.