Systemic Lupus Erythematosus

Clinically, in SLE there are erythematous patches. In early lesions, histopathologic changes of SLE can show indifferent changes that may be unspecific, including discrete vacuolar degeneration of the basal layer, edema, and a discrete lymphocytic infiltrate in the upper dermis. Well-established lesions show prominent vacuolar degeneration of the basal membrane, edema, extravasation of erythrocytes, and a lymphocytic infiltrate in the upper dermis. Neutrophils are sometimes present in early lesions at the dermoepidermal junction. Fibrinoid material may be present in the dermis around vessels and between collagen strands. In individual cases, distinction from leukocytoclastic vasculitis is impossible because all of the signs of leukocy-toclastic vasculitis may be present, including nuclear dust, fibrinoid necrosis of vessel walls, neutrophilic infiltrate, and extravasation of erythrocytes. Eosinophils may be present in some drug-induced cases. Mucin can be present in larger amounts in the dermis and can be verified by using special stains (Alcian blue). The subcutaneous fat is frequently involved, with changes that are similar to those seen in LE profundus (see the following section).

The differential diagnosis includes polymorphous light eruption that usually does not exhibit larger amounts of mucin. Leukocytoclastic vasculitis does not show prominent mucin deposition or vacuolar degeneration of the basal layer.

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