Acute Cutaneous Lupus Erythematosus

Subacute Cutaneous Lupus Erythematosus

The typical clinical manifestations of ACLE are characterized by a localized erythema known as the malar rash or butterfly rash on the central portion of the face or by a generalized, more widespread form Fabbri et al. 2003, Sontheimer and Provost 2003 . Localized ACLE may only affect the skin transiently, and the lesions may last for only several days up to a few weeks. Therefore, at the onset of disease, the patients may mistake this rash for sunburn and may seek medical advice only after the...

Bullous Lesions in Lupus Erythematosus

Lupus Tumidus

The frequency of bullous lesions associated with LE BLE is low, and it has been reported that less than 5 of patients with SLE and skin changes had chronic vesicu-lobullous lesions Gammon and Briggaman 1993, Yell and Wojnarowska 1997 . Confusion has always existed concerning the nosology and classification of the bullous skin changes that can occur in patients with LE, and there has been no consensus in this area for a long time. In 1997, Sontheimer Sontheimer 1997 divided the various types of...

Lupus Erythematosus Profundus

Lupus Profundus

LEP, historically referred to as Kaposi-Irgang disease or also known as lupus pan-niculitis, is a rare variant of CCLE in which pathologic changes occur primarily in the lower dermis and subcutaneous tissue. In 1883, subcutaneous nodules associated with LE were first described by Kaposi Kaposi 1883 , but the term lupus profundus was coined by Irgang Irgang 1940 in 1940. Subsequently, different authors reported new cases and contributed to define the clinical and histopathologic characteristics...

Discoid Lupus Erythematosus

Discoid Lip

The most common form of all chronic cutaneous variants is DLE, which can be localized or generalized, both with and without systemic manifestations of LE. Typical DLE lesions may be present at the onset of SLE in about 5 -10 of patients, and approximately 30 of patients may develop DLE lesions, usually of the generalized type, during the course of SLE Cervera et al. 1993,Hymes and Jordon 1989,Tebbe et al. 1997 . The localized form presents with sharply demarcated, erythematokeratotic, atrophic...

Discoid Lupus Erythematosus of the Palms and Soles

DLE of the palms and soles is a rare occurrence characterized by sharply demarcated erythemas and adherent scaling the lesions tend to be painful and may become erosive. Atrophy and scarring are the features that allow a distinction from the following Palmoplantarpsoriasis has no signs of atrophy. Note that palmoplantar psoriasis is only rarely an isolated finding. Keratoderma blennorhagicum in patients with Reiter's disease presents with pso-riasiform palmoplantar lesions composed of...

Subacute Cutaneous Lupus Erythematosus

Subacute Cutaneous Lupus Lesions

The composition and pattern of immune deposits in lesional SCLE skin are similar to those seen in DLE Meurer and Bieber 1987 . The LBT in lesional skin is positive in 60 -100 of biopsy samples from SCLE lesions the frequency may vary with the Table 22.1. Direct immunofluorescence findings IgG in lupus erythematosus LE Table 22.1. Direct immunofluorescence findings IgG in lupus erythematosus LE Fig. 22.1. Linear, bandlike deposits of IgM along the dermoepider-mal junction of a chronic discoid...

Old burntout Lesions of Discoid Lupus Erythematosus

Cutaneous Lupus Hyperpigmented

Long lasting DLE lesions are dominated by atrophy, scarring, and depigmentation. Atrophic scars may be indistinguishable from burnt-out DLE, lacking any signs of inflammation, particularly depigmented scars after superficial third-degree burns. Atrophic acne scars differ by their multiplicity and characteristic distribution. They are not accompanied by pigmentary changes in white skin. The characteristically depressed scars after cutaneous leishmaniosis, in contrast, are hyperpigmented. In all...

Differential Diagnosis at Particular Sites Discoid Lupus Erythematosus of the Scalp

Scutula Favus

DLE of the scalp Fig. 11.2A typically arises as one or a few roundish erythematous plaques identical to DLE lesions elsewhere on the skin. When atrophy develops, they gradually transform into patches of scarring alopecia that may be surrounded by rims of scaly erythema. In the early phase, it must be distinguished from psoriasis and seborrheic dermatitis see previously herein . In advanced stages, DLE may Fig. 11.2. A Atrophic alopecia in discoid lupus erythematosus. Note the widened...

Subacute Cutaneos Lupus Erythematosus Differential Diagnosis

Psoriasis Erythematosus

Subacute CLE (SCLE) is an exanthematic skin condition with a typical clinical appearance (diagnosis can often be made before the presence of Ro SSA antibodies is documented) that is localized at the trunk and the extensor aspects of the upper extremities, more rarely in the face and neck (Sontheimer et al. 1979). Lesions have an intermediate morphology between DLE and SLE they are erythematous flat plaques, much thinner than DLE, with some dry scaling but without adherent scales and...