Cutaneous Lupus Erythematosus
SLEAutoimmune 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.
Criteriaمطلوبة
Butterfly rash
Discoid lupus
Photosensitivity
Oral ulcers
Arthritis
Serositis
Neurologic
Hematologic
Renal
Immunologic: anti-DNA, anti-phospholipid
Anti-nuclear antibody
Types of cutaneous lupus مطلوبة
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 مطلوبة
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
المطلوب فقط criteria, types, treatment