Erythema Multiforme and Lupus Erythematosus Rowells Syndrome

In 1963, Rowell et al. (Rowell et al. 1963) described four patients with the clinical picture of chronic DLE associated with erythema multiforme (EM). Besides the skin changes compatible with both diseases, the patients had characteristic immunologic findings consisting of the speckled type of ANAs, the anti-SjT type of precipitating antibody to saline extract of human tissues and rheumatoid factor. In some patients, perniotic-like lesions were also observed. Later it turned out that SjT is identical to anti-La/SSB or anti-Ro/SSA antibodies. Several cases with this unusual picture have been reported subsequently, and this distinctive subset of LE is called "Rowell's syndrome." Twenty-seven cases of the syndrome had been reported by 1989. Our group observed a 30-year-old man who had DLE, EM-like lesions, and ANAs in a low titer (Pramatarov et al. 1983). SjT antibodies were not studied. Four additional cases were reported later. Parodi et al. (Parodi et al. 1989), in 1989, described a 62-year-old man with DLE and EM. They reviewed the previous reported cases and suggested that most are cases of coincidental association of LE and EM. Their review revealed that none of the cases reported after that described by Rowell covered the diagnostic criteria of the syndrome. In 1995,Fiallo et al.(Fiallo et al. 1995) described a 19-year-old man with SLE and annular polycyclic lesions on the cheeks, upper trunk, back, and arms. They believed that Rowell's syndrome was a distinct entity and that their patient was additional evidence for its existence. In 1996, Fitzgerald et al. (Fitzgerald et al. 1996) described a 47-year-old woman with a long history of EM-like eruptions in association with LE. The patient had a speckledANA pattern, and the authors believed that she met the criteria for Rowell's syndrome and that this syndrome is a distinct clinical and immunologic entity. In 1996, Chua et al. (Chua et al. 1996) described a 9-year-old girl with SLE and ANA titer of 1:640 who also had necrotizing lymphadenitis. In 1999, Shteyngarts et al. (Shteyngarts et al. 1999) described a 34-year-old woman with a history of SLE with concomitant EM lesions. The case was compared with other cases with Rowell's syndrome. Their belief is that the coexistence of LE and EM does not impart any unusual characteristics to either disease and that the immunologic disturbances in such patients are probably coincidental. In 2000, Roustan et al. (Roustan et al. 2000) described a 27-year-old woman with EM-like lesions. They also reviewed the cases of Rowell's syndrome reported previously and declared that the main clinical and immunologic findings are not distinctive and could be detected in various subtypes of LE. Roustan et al. believed that their patient might be included in so-called Rowell's syndrome but with the clinical picture of SCLE. In 1999, Marzano et al. (Marzano et al. 1999) described a woman with LE and long-standing vesiculobullous EM-like lesions and typical laboratory findings of the antiphospholipid syndrome. The case could be consistent with the diagnosis of Rowell's syndrome, if the latter is regarded as a clinical entity. In conclusion,the existence of Rowell's syndrome is still disputable since few, if any, cases met the criteria of the originally reported cases by Rowell,but coexistence of LE and EM is possible and well documented. EM-like lesions can appear in patients with DLE, as it was in the original article by Rowell, they can also appear in patients with SLE, and they might be a clinical picture of SCLE. Moreover, in 1989, Sontheimer (Sontheimer 1989) stressed that the annular polycyclic changes may resemble EM.

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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