subacute cutaneous lupus erythematosus
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Etiology
- precipitating factors:
Epidemiology
- 10% of patients with lupus erythematosus
- young & middle aged individuals
- uncommon in black & hispanics
- females > males
Pathology
- liquefaction degeneration of the epidermal basal layer
- edema of the upper dermis
- vesicles may be present
- colloid bodies in the epidermis
- 40% have immune deposits in the dermal-epidermal junction
Clinical manifestations
- sudden onset of annular or psoriasiform lesions
- crusted margins & central hypopigmentation with annular lesions
- confluent malar erythema (no subacute cutaneous lupus[2])
- generalized erythematous papules or urticaria
- no follicular plugging
- no scarring, little atrophy
- distribution: light exposed areas: shoulders, arms, dorsal aspect of hands, upper trunk
- non-scarring alopecia
- periungual telangiectasias
- tends to burn more than itch
- patients may have a few of the criteria of SLE
- serious manifestations of SLE are uncommon
- severe vasculitis
- severe CNS disease
- progressive renal disease
- 50% of patients do not have systemic manifestations of SLE
- fatigue, malaise
- arthralgias
- fever
Laboratory
- serology
- anti-Ro (SSA) antibodies (80%)
- anti-La (SSB) antibodies
- low titers of antinuclear antibodies (ANA)
- antibodies against EEA1 (not specific)
- circulating immune complexes
- skin biopsy
Differential diagnosis
- dermatomyositis
- secondary syphilis
- psoriasis tends to improve with sunlight[2]
- seborrheic dermatitis
- tinea corporis
Management
- sunscreen, protective clothing
- topical corticosteroids are sometimes helpful
- systemic therapy
- thalidomide 100-300 mg PO QD
- very effective for skin lesions
- hydroxychloroquine 400 mg PO QD, plus (if needed) quinacrine hydrochloride 100 mg PO QD
- thalidomide 100-300 mg PO QD
More general terms
Additional terms
- anti-nuclear antibody (ANA) in serum
- dermatomyositis
- hydroxychloroquine (Plaquenil)
- psoriasis
- quinacrine; mepacrine (Atrabine)
- seborrheic dermatitis; seborrhea; cradle cap (infants)
- SSA/Ro Ab in serum
- SSB/La Ab in serum
- syphilis
- thalidomide (Thalamid, Corronarobetin)
- Tinea corporis
References
- ↑ Color Atlas & Synopsis of Clinical Dermatology, Common & Serious Diseases, 3rd ed, Fitzpatrick et al, McGraw Hill, NY, 1997, pg 350-51
- ↑ 2.0 2.1 2.2 2.3 Medical Knowledge Self Assessment Program (MKSAP) 15, 16, 17, 18, 19. American College of Physicians, Philadelphia 2009, 2012, 2015, 2018, 2022.
- ↑ Walling HW, Sontheimer RD. Cutaneous lupus erythematosus: issues in diagnosis and treatment. Am J Clin Dermatol. 2009;10(6):365-81 PMID: https://www.ncbi.nlm.nih.gov/pubmed/19824738
- ↑ 4.0 4.1 Lin J, James WD (images) Medscape: Subacute Cutaneous Lupus Erythematosus (SCLE) http://emedicine.medscape.com/article/1065657-overview
- ↑ 5.0 5.1 DermNet NZ. Cutaneous lupus erythematosus (images) http://www.dermnetnz.org/immune/cutaneous-lupus.html
- ↑ Lowe GC, Henderson CL, Grau RH, Hansen CB, Sontheimer RD. A systematic review of drug-induced subacute cutaneous lupus erythematosus. Br J Dermatol. 2011 Mar;164(3):465-72 PMID: https://www.ncbi.nlm.nih.gov/pubmed/21039412
- ↑ Grunhagen CM, Fored CM, Linder M, Granath F, Nyberg F. Subacute cutaneous lupus erythematosus and its association with drugs: a population-based matched case-control study of 234 patients in Sweden. Br J Dermatol. 2012 Aug;167(2):296-305. Epub 2012 Jul 5. PMID: https://www.ncbi.nlm.nih.gov/pubmed/22458771