BACKGROUND: Systemic lupus erythematosus (SLE) may involve any number of organ 
systems and varies greatly in the severity and type of involvement. Cutaneous 
manifestations of SLE are equally numerous and varied throughout the course of 
the disease within an individual, as well as varying between patients. Cutaneous 
manifestations of SLE are frequently the presenting symptoms, typically noted in 
the classic malar "butterfly" rash; however, other cutaneous patterns are 
frequently observed.
METHODS: We present here two patients who presented with what was thought to be 
acne refractory to treatment.
RESULTS: These patients actually were found to have a facial eruption associated 
with SLE as confirmed by skin biopsy.
CONCLUSIONS: The importance of investigating atypical or treatment-resistant 
eruptions, especially in patients experiencing other symptoms, is emphasized.