Cutaneous Lupus Erythematosus

Cutaneous Lupus Erythematosus

SLE
Autoimmune disease that affects multisystems 1.5 million cases of lupus Prevalence of 17 to 48 per 100,000 population Women > Men - 9:1 ratio African Americans > Whites Onset usually between ages of 15 and 45 years, Can occur in childhood or later in life

Clinical Manifestations

For the purpose of identifying patients in clinical studies, a person has SLE if 4 or more of the 11 criteria are present, serially or simultaneously, during any interval of observation. (specificity 95%, sensitivity 75%). It is important to remember that a patient may have SLE and not have 4 criteria.

Criteria

Butterfly rash Discoid lupus Photosensitivity Oral ulcers Arthritis Serositis
Neurologic Hematologic Renal Immunologic: anti-DNA, anti-phospholipid Anti-nuclear antibody

Types of cutaneous lupus

Acute Subacute Chronic (discoid) Lupus profundus


Most common type is the acute, rash is photosensitive, raised erythematous malar rash. Discoid Lupus Erythematosus (DLE): Plugged hair follicles and adherent scale. Atrophy or thinning of the top layer of skin. Hardness of the skin. Telangiectasias. Erythema. Scarring & permanent hair loss can develop Subacute, less common, usually affects the sun exposed areas (polycyclic lesions).


Malar Rash

Discoid Rash

Investigations
ANA (indirect immuno-fluorescence )Anti ds-DNA antibodyENA (Ro, La antibodies） (immuno-blot)LBT lupus band test (direct immuno-fluorescence )Biopsy

Treatment

Topical steroids (potent ones or intralesional injections in case of discoid lupus) Sunscreens are mandatory in all cases Antimalarial agents: Hydroxychloroquin 200 mg twice daily. Systemic steroids, only for systemic involvement. Immunosuppressives