Laboratory Evaluation

Skin biopsy is not always performed owing to the age of the child and the predilection of lesions for the face. Biopsy findings for histologic examination and immunofluorescence are consistent with the findings of SCLE (David-Bajar et al. 1992). Notably, there is basal cell damage and a lymphocytic inflammatory infiltrate in the upper dermis. Histologic features more closely associated with discoid lupus, such as an intense deep dermal inflammatory infiltrate, an intense periadnexal infiltrate, fol-licular plugging, and basement membrane thickening, are not prominent in NLE. In the author's experience, the immunofluorescent finding characteristic of cutaneous NLE is epidermal particulate deposition of IgG. This finding can be reproduced in an animal model by infusion of anti-Ro/SSA antibodies (Lee et al. 1986,1989).

Autoantibody testing of serum samples from the mother, the child, or both is important for diagnosis. The exact specificity or specificities responsible for NLE are debated, but there is no question that virtually all patients have autoantibodies of the Ro/SSA family. Autoantibodies reported to be associated with NLE include antibodies to 60-kDa Ro/SSA, 52-kDa Ro/SSA, La/SSB, calreticulin, alpha-fodrin, a 57-kDa protein, and a 75-kDa phosphoprotein (Buyon et al. 1994, Maddison et al. 1995, Miya-gawa et al. 1998, Lee et al. 1994, Lieu et al. 1989, Wang et al. 1999, Weston et al. 1982). In a few cases of cutaneous NLE, antibodies to Ro/SSA were not detected but antibodies to U1RNP were (Provost et al. 1987). Many of the assays for autoantibodies associated with NLE are performed only in certain research laboratories. For the clinician, assays for antibodies to Ro/SSA, La/SSB, and U1RNP are commercially available and should suffice to confirm or, if negative, seriously question the diagnosis.

It is reasonable to evaluate children with cutaneous NLE for extracutaneous manifestations. Laboratory screening may include electrocardiography, liver function tests (transaminases and fractionated bilirubin), and a complete blood cell count with differential.

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