Cutaneous Lupus Erythematosus

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Fifth stage 

Dermatology 

Lec-15

 .د

  عمر

18/4/2016

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 

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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). 

Investigations

: 

  ANA 

  (indirect immuno-fluorescence ) 

  Anti ds-DNA antibody 
  ENA (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