ANAs in Cutaneous Lupus Erythematosus

SLE is a multisystem disorder with symptoms spanning from relatively benign cutaneous eruption to a severe, in some cases fatal, systemic disease. Although SLE can affect virtually every organ, abnormalities of the skin or mucous membranes are very frequent, being the second most common manifestation of SLE. Cutaneous lesions occur in approximately 85% of patients with SLE and are associated with photosen-sitivity, which may be linked to the pathogenesis of the underlying autoimmune response. The idea is that ultraviolet (UV) irradiation of the skin may expose previously cryptic antigens on the cell surface of epidermal cells, which, in turn, may be recognized by autoantibodies and T cells as foreign components, leading to (a) a systemic autoimmune response and (b) production of lupus skin lesions.

Four subsets of cutaneous LE (CLE) have been defined: acute CLE (ACLE), subacute CLE (SCLE), chronic CLE (CCLE),and neonatal LE (NLE).In SCLE andNLE,the occurrence of specific autoantibodies against components of the cell nucleus has been observed. SCLE is defined by a nonscarring skin eruption in association with autoantibodies against Ro/SSA (Fig. 24.1) (Gilliam 1977, Sontheimer et al. 1979). Fifty percent of these patients fulfill the criteria of the American Rheumatism Association for SLE established in 1982 (Tan et al. 1982). Depending on the detection method, 60% to 95% of patients with SCLE have anti-Ro/SSA antibodies in their serum.

NLE is a rare disease with skin manifestations resembling those seen in SCLE (Lee 1993). Approximately one half of the NLE cases exhibit skin disease, the other half

1979 Lupus Erythematosus

Fig. 24.1. Subcellular distribution of Ro/SSA. A Indirect immunofluorescence and confocal microscopy of HEp-2 cells with subacute cutaneous lupus erythematosus (SCLE) autoanti-bodies against Ro/SSA revealed bright speckles embedded in a weaker homogeneous staining pattern (green) within the nucleoplasm. Confocal sectioning was conducted by recording focal planes from the bottom to the top of one cell (intervals, 1 |im). Note that single Ro speckles occur in three to four focal planes (red arrows). B Focal sections displayed in A were fused to one stack (left micrograph, green). The morphology of the cell was recorded simultaneously by differential interference contrast (right micrograph, gray). Nu, nucleoplasm; No, nucleolus; Cy, cytoplasm. Bar, 5 |im. C Immunoblotting of patient sera against Ro60 and Ro52. Patient serum 1 recognizes both, Ro60 and Ro52, whereas serum 2 is exclusively directed against Ro52. Confocal microscopy was conducted with serum 2. Molecular weight (MW) is given in kilodaltons

Fig. 24.1. Subcellular distribution of Ro/SSA. A Indirect immunofluorescence and confocal microscopy of HEp-2 cells with subacute cutaneous lupus erythematosus (SCLE) autoanti-bodies against Ro/SSA revealed bright speckles embedded in a weaker homogeneous staining pattern (green) within the nucleoplasm. Confocal sectioning was conducted by recording focal planes from the bottom to the top of one cell (intervals, 1 |im). Note that single Ro speckles occur in three to four focal planes (red arrows). B Focal sections displayed in A were fused to one stack (left micrograph, green). The morphology of the cell was recorded simultaneously by differential interference contrast (right micrograph, gray). Nu, nucleoplasm; No, nucleolus; Cy, cytoplasm. Bar, 5 |im. C Immunoblotting of patient sera against Ro60 and Ro52. Patient serum 1 recognizes both, Ro60 and Ro52, whereas serum 2 is exclusively directed against Ro52. Confocal microscopy was conducted with serum 2. Molecular weight (MW) is given in kilodaltons have congenital heart block (Michaelsson and Engle 1972), and approximately 10% have both skin disease and congenital heart block. The hallmark of NLE is that in approximately 95% of the cases, the serum of both the baby and the mother contains autoantibodies directed against Ro/SSA (Franco et al 1980, Lee and Weston 1988). In contrast, other ANA specificities are rarely found (Provost et al. 1987). Anti-Ro/SSA autoantibodies are so characteristically prevalent in SCLE and NLE that clinicians usually use these ANA specificities as a confirmatory diagnostic test in patients who present with symptoms of the disorders.

However, the presence of these antibodies is not simply a matter of diagnostic or academic interest. Anti-Ro/SSA antibodies have been eluted from kidneys of patients with SLE (Maddison and Reichlin 1979) and are commonly associated with photosensitive rashes. Antibodies to Ro/SSA can cross the placenta and induce in approximately 1 of 20 cases NLE. Therefore, many investigators have explored the structure, origins, and precise targets of anti-Ro/SSA autoantibodies.

How To Deal With Rosacea and Eczema

How To Deal With Rosacea and Eczema

Rosacea and Eczema are two skin conditions that are fairly commonly found throughout the world. Each of them is characterized by different features, and can be both discomfiting as well as result in undesirable appearance features. In a nutshell, theyre problems that many would want to deal with.

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