Maculopapular Exanthemas

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Generalized exanthemas of SLE may appear as transitory indistinct morbilliform macular rashes that regress after hours or days and may wax and wane parallel to disease activity; they may persist, however, and transform into more stable macular lesions that are well demarcated, are slightly hypertrophic and scaly, and somewhat resemble the lesions of SCLE. Some may acquire annular shapes or a tylotic morphology (e. g., chilblain lupus). All exanthemas of SLE, except the morbilliform rashes, are situated in the light-exposed areas (face,V region of the neck, extensor surfaces of the arms, wrists, and dorsa of the fingers). Following regression, they leave no atrophy or depigmentation (rather, hyperpigmentation in dark skin). Macular eruptions are clinically much less characteristic than the stable lesions.

Macular drug eruptions and viral exanthemas may be morphologically indistinguishable except for the clear predilection of SLE exanthemas for light-exposed areas. Also, SLE exanthemas lack the characteristic symptoms associated with some viral eruptions (such as lymphadenopathy, "catarrhalic" rhinitis and conjunctivitis in rubella, Koplik spots in measles). Constitutional symptoms (fever, malaise, and arthralgias) are little contributory for differential diagnosis because they may occur in all; moreover, episodes of SLE may be precipitated by viral infections, and the respective symptoms may occur simultaneously or in short succession.

Erythema annulare centrifugum may mimic stable lesions of SLE (see previously herein).

Acral maculopapular lesions of dermatomyositis resemble acral maculopapular lesions of SLE. Both appear as reddish and slightly elevated scaly papules of the dorsa of the fingers; there is a peculiar and unexplained difference, however, in that the lesions of dermatomyositis are localized over the interphalangeal joints and spare the skin in between, whereas the opposite is true for the lesions of SLE. Also, those of der-matomyositis are more elevated and hyperkeratotic; nailfold erythemas, telangi-ectasias, and hemorrhage may occur in both conditions but are more pronounced in dermatomyositis.

Acral vasculitic skin lesions in SLE present as flat, erythematous palmoplantar painful plaques or nodules and resemble chilblains ("chilblain lupus"). These lesions are also typically found in LE-like syndromes of C2 or C4 deficiency.

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