Lupus Erythematosus and Bullous Diseases

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Vesiculobullous eruptions predominantly appear in patients with SLE. Loche et al. (Loche et al. 1998) divided vesiculobullous eruptions in SLE into three groups: in the first group, blistering may appear in patients with SLE owing to cutaneous fragility; in the second group, vesiculobullous eruptions are the main clinical features of a distinct clinical entity called bullous SLE; and in the third group, SLE may be primarily associated with bullous diseases.

Because the association between LE and pemphigus is considered generally to be pemphigus erythematosus only, a few cases of coexistence of both diseases have been reported. Fong et al. in 1985 described a 59-year-old Chinese woman with LE preceding pemphigus. Their patient met the criteria for both diagnoses. In the report by Kuchabal et al. (Kuchabal et al. 1998), pemphigus preceded the development of SLE in a 15-year-old Indian girl.

In 1998, Loche et al. (Loche et al. 1998) described a 52-year-old woman who had SLE according to the criteria of American Rheumatism Association (ARA) and who 6 years later developed localized bullous pemphigoid. Loche et al. reviewed the previously reported cases with the coexistence of SLE and bullous pemphigoid. Nine cases of bullous pemphigoid associated with SLE were reported by 1998. In four cases, SLE preceded the appearance of bullous pemphigoid. Not all of the reported cases had the typical clinical presentation. Direct immunofluorescence showed deposition of IgG only at the basement membrane zone (BMZ) in three patients and of IgG with complement in five. Indirect immunofluorescence revealed circulating anti-BMZ antibodies in four patients. The authors believed that since there is plenty of autoimmune antibodies in SLE, one of them can be directed against the bullous pemphigoid antigen. Huang et al. in 1997 described a 77-year-old patient with a history of vesiculo-bullous eruptions specified as bullous pemphigoid of 3 months' duration. Several months later, because of the patient's deteriorated condition, SLE was diagnosed. Several cases with this coexistence have been previously reported, but some were not convincing (Jordan et al. 1969, Kumar et al. 1978, Miler et al. 1978).

An association between SLE and dermatitis herpetiformis is rare. A few cases with this association have been reported, and two of them deserve attention. The patient described by Aronson et al. (Aronson et al. 1979) also had Marfan's syndrome. The patient described by Vandersteen et al. (Vandersteen et al. 1974) had dermatitis her-petiformis and later developed DLE, probably induced by sulfone.

A few cases of coexistent linear IgA disease and SLE have been reported. The first, described in 1983 by Thaipisuttikul et al. (Thaipisuttikul et al. 1983), was a patient with SLE who later developed linear IgA disease. Lau et al. (Lau et al. 1991), in 1991, described a 35-year-old woman with a history of SLE who developed linear IgA disease 22 years later. Both patients had gluten-dependent enteropathy and responded dramatically to treatment with dapsone. Epidermolysis bullosa acquisita in association with SLE also has been reported (Dotson et al. 1981)

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