lupus panniculitis (lupus erythematosus profundus)

Introduction

Severe form of discoid lupus, but may occur in systemic lupus erythematosus.

Pathology

(dermatopathology)

• subcutaneous tissue
• necrobiosis with fibrinoid deposits
• dense lymphocytic infiltrates
• late lesions
  • hyalinization of fat lobules
  • mucinous deposits
  • vasculitis (rare)

Clinical manifestations

• firm, circumscribed nodules or plaques of face, scalp, breasts, upper arms, thighs & buttocks
  • generally no grossly visible epidermal changes
  • indurated subcutaneous edema with overlying erythema
  • lesions my ulcerate
  • lesions may be slightly tender or painful
  • lesions may precede or follow lesions of discoid lupus by several years
• most patients also have lesions typical of discoid lupus
• 35% of patients may have mild SLE

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Differential diagnosis

• morphea
• erythema nodosum
• sarcoid

Management

(same as for discoid lupus)

• topical corticosteroids
• intralesional triamcinolone acetonide 3-5 mg/mL
• hydroxychloroquine 100 mg PO QD, up to 6.5 mg/kg/day, plus (if needed) quinacrine hydrochloride 100 mg PO QD
• etretinate 1 mg/kg/day
• prevention: topical sunscreens (SPF 30)

More general terms

• discoid lupus (chronic cutaneous lupus erythematosus)
• panniculitis