Foreword

A comprehensive, in-depth monograph such as this focused entirely on the subject of the cutaneous manifestations of lupus erythematosus (LE) is long overdue!

LE is increasingly being recognized as a more common autoimmune disorder than was previously thought, and the cutaneous manifestations of LE are among the most common clinical features of LE at its onset and throughout its course. The most commonly recognized environmental risk factor for LE, ultraviolet light exposure from sunlight and artificial sources, necessarily transduces its disease-exacerbating effect through the skin. Cutaneous LE can be a significant contributor to psychosocial and occupational disability. In addition, the universally recognized symbols of LE - the butterfly and the wolf - relate to different cutaneous manifestations of LE.

Yet, the skin has been the least well-studied organ system that is affected by LE. This has resulted from the relative "invisibility" of the skin and skin disease to non-dermatologists who deal with patients with LE. After all,"it's only a rash." Perhaps this would be less of a problem if nondermatologist physicians were better trained in the principles and practice of recognizing and managing skin diseases during their formal medical education. Also, contributing to this is the fact that expert management of LE and rheumatic skin disease in general are at risk of being lost from the dermatologist's repertoire in some parts of the world, including the United States.

However, to a relatively small subset of academic dermatologists who subspecial-ize in the cutaneous manifestations of LE, the protean changes that can occur in the skin of patients with LE can be both fascinating and daunting. How a single disease process plays out so many different themes in a single organ system is truly amazing! This matrix becomes even more complex when one considers the relationships that exist between the various morphologic varieties of skin change in patients with LE and the various systemic manifestations of LE. Much is yet to be learned in this area!

We are indeed fortunate that Drs. Kuhn, Lehmann, and Ruzicka have assembled a highly experienced and expert group of individuals to address the various subjects presented in this monograph. From my perspective, this has been a wonderful, soup-to-nuts tour of our current understanding of all major aspects of LE skin disease. It is my hope that this effort will catalyze further thought and progress in this area.

Iowa City, Iowa, USA June 2004

Richard D. Sontheimer

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