Lupus erythematosus profundus (LEP) is a rare form of chronic cutaneous lupus erythematosus. We report the case of a 60-year-old Caucasian woman who presented with discrete erythematous patches and nodules, located on the lower abdomen and posterior lumbar region. Progressively, the red patches involved the mammary glands and the face. The clinical exam did not reveal any other abnormalities. High frequency ultrasound (HFUS) of the rash was performed and showed a vasculitic process in the deep dermis and hypodermis. A skin biopsy from the abdomen was initially nonspecific. Correlating the HFUS findings, we asked the pathologist to examine more profound sections, including the adipose tissue. Thus, the deeper sections revealed a vasculitic process and lobular panniculitis, with a dense infiltrate of lymphocytes, confirming the diagnosis of LEP. The clinical and laboratory examinations ruled out systemic lupus erythematosus. Treatment with topical and systemic steroids was first administered and once we had the histological confirmation of diagnosis, the patient was started on Hidroxichloroquine, with good clinical response. Our case report highlights the importance of using new techniques (HFUS) for a more accurate diagnosis.