The process is more uniform without focal areas of more significant destruction of basal keratinocytes. In addition in contrast to the toilet of the defects in a lichen planus-like reaction, there is no fibrous inlay of the defects and no entrapment of colloid bodies in the fibrous tissue newly formed in defects. Colloid bodies are few in number in the collagen-vascular variants. There is atrophy of the basal unit and often complete effacement of rete ridges in the collagen-vascular variant. It may on occasion be associated with patterns of pseudoepitheliomatous hyperplasia, particularly from follicular components.
Inflammation is more severe in the discoid variants.
Subacute LE is an exception with a prominence of necrotic keratinocytes in the epidermis and upward migration of the necrotic cells. It shares features with graft vs. host reaction. Generally, the epidermal response in lupus erythematosus is atrophy of the basal layer and hypertrophy of the cells of the superficial unit of the epidermis. The expanding follicular epithelium may crowd the surface epithelium to the point that the epidermal changes are inconspicuous and overshadowed by the follicular changes. Such a lesion may be misdiagnosed as carcinoma or as pseudoepitheliomatous hyperplasia without an appreciation for the associated cell-poor lichenoid reaction.