Of Cutaneous Lupus Erythematosus

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Percy Lehmann

The term lupus erythemateaux was used for the first time by Cazenave (Cazenave 1851) in 1851 to distinguish the noninfectious forms of lupus from cutaneous tuberculosis (lupus vulgaris). Cazenave referred in his original paper to Biett's earlier report on this disease, which was termed erytheme centrifuge, as being a very good description of what nowadays would be called discoid lupus erythematosus (DLE). Also, in 1845, Hebra (Hebra 1845) precisely described systemic manifestations of LE that occurred in patients who had the classic "butterfly erythema," which he named "seborrhea congestive". Since the earlier descriptions had always discussed LE in the context of cutaneous tuberculosis, it is very much Cazenave's achievement to have clearly separated LE from an infectious disease, thus clearing the way for further studies on this complex disease following other hypotheses and directions.

Based on Hebra's work, further clinical and histopathologic studies on the relation of cutaneous lesions and systemic manifestations of LE were performed. Kaposi (Kaposi 1869,1872,1880) recognized the relationship of DLE and systemic LE (SLE) and extensively described the butterfly erythema as a facial cutaneous sign of SLE. Accordingly, through his continuous efforts, which are reflected in several publications between 1869 and 1880, Kaposi is nowadays recognized as the first describer of SLE. In 1872, Kaposi described SLE as an acute febrile eruption with pronounced painful joint involvement and a characteristic facial erythema that he termed "erysipelas perstans faciei" (Fig. 4.1).

The most extensive description on the systemic manifestations of LE at that time must be referred to Osler in 1895 (Osler 1895) in his work titled "On the visceral complications of erythema exsudativum multiforme". Although he had not adopted the term "lupus erythematosus" from his European colleagues, he based his studies on their work, and, thus, the investigations dealing with this fascinating and complex disease reached the New World by the end of the 19th century.

In an article published by the Journal of the American Medical Association in 1923, Goeckerman (Goeckerman 1923) pointed again in depth to the systemic nature of LE ("lupus erythematosus as a systemic disease"). In Europe, Hutchinson (Hutchinson 1888) emphasized at the end of the 19th century the multisystem nature of LE and the different expressions and variations of the disease with respect to cutaneous and systemic manifestations in different patients.

In summary, the complex disease LE was first recognized and evaluated by its visible cutaneous manifestations before the analysis and study of its systemic manifestations established the multisystem nature of LE.

Handatlas Kaposi
Fig. 4.1. Historical drawing of cutaneous lupus erythematosus (from Kaposi's Handatlas der Hautkrankheiten [Kaposi 1898])

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