Of Cutaneous Lupus Erythematosus

Florian Weber, Peter Fritsch

The cutaneous manifestations of lupus erythematosus (LE) are notoriously diverse and may mimic a broad range of unrelated skin disorders, although many of its skin symptoms are straightforward and pose few diagnostic problems. Clinical differential diagnosis has a place in directing the dermatologist toward the correct diagnosis in the primary screening process. This chapter summarizes the diagnostic considerations at this point, before additional diagnostic procedures are carried out. Of course, a definite diagnosis of LE must be based on the whole of the clinical appearance, history, and the histopathologic, immunofluorescent, laboratory, and, occasionally, phototesting findings (see the respective sections of this book). Obviously, no reference to these investigational procedures are made in this chapter.

The main building blocks that make up the cutaneous lesions of LE are the classic triad of erythema, scaling, and atrophy. The relative weight of these elements, however, is subject to variation according to the type of LE (chronic cutaneous, subacute cutaneous, and systemic), the age and location of the lesions, and the presence of additional morphologic features (e.g., hypertrophy, adipose tissue involvement, and mucopolysaccharide accumulation). Erythema, epidermal thickening and scaling, and atrophy and scarring represent a clinical and dynamic continuum along which all lesions of cutaneous LE (CLE) develop; only the chronic discoid type, however, may go all the way, whereas the other types hold in earlier stages. For this reason, there is a considerable morphological overlap between all types of CLE, and many differential diagnostic considerations pertain to more than one or all types of LE, as will be seen below.

According to an old saying, LE and syphilis are the "great imitators" among the skin diseases. We tried to list only reasonable and practically useful differential diagnoses and may have missed a few less appropriate ones. It must also be borne in mind that erythema, scaling, and atrophy are fairly common cutaneous features. Single LE lesions, particularly fresh ones, may thus be totally indistinguishable from single lesions of a score of other dermatoses; only in the frame of the clinical appearance as a whole does the diagnosis appear obvious and unmistakable.We tried to satisfy both aspects in this chapter.

As the structural framework for differential diagnoses, we used the accepted classification of LE as laid down in the textbooks of dermatology (Braun-Falco et al. 1997, Champion et al. 1998, Fitzpatrick et al. 1999, Fritsch 1998).

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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