Cutaneous Lupus

Acute cutaneous lupus erythematosus LE is characterized by erythema of the nose and malar eminences in a "butterfly" distribution. The erythema is often sudden in onset, accompanied by edema and fine scale, and correlated with systemic involvement.

Subacute cutaneous lupus erythematosus (SCLE) is characterized by a widespread photosensitive, nonscarring eruption. About half of these patients have SLE in which severe renal and central nervous system involvement is uncommon. SCLE may present as a papulosquamous eruption that resembles psoriasis or annular lesions that resemble those seen in erythema multiforme. In the papulosquamous form, discrete erythematous papules arise on the back, chest, shoulders, extensor surfaces of the arms, and the dorsum of the hands; lesions are uncommon on the face, flexor surfaces of the arms, and below the waist. The slightly scaling papules tend to merge into large plaques, some with a reticulate appearance.

Discoid lupus erythematosus (DLE) is characterized by discrete lesions, most often on the face, scalp, or external ears. The lesions are erythematous papules or plaques with a thick, adherent scale that occludes hair follicles (follicular plugging). When the scale is removed, its underside will show small excrescences that correlate with the openings of hair follicles and is termed a "carpet tack" appearance.

Treatment of Cutaneous Lupus

Direct immunofluorescence microscopy of lesional skin frequently reveals deposits of immunoglobulin(s) and complement in the epidermal basement membrane zone. Treatment is aimed at control of systemic disease; photoprotection in this, as well as in other forms of LE, is very important. A particulate pattern of IgG deposition around basal keratinocytes has recently been associated with SCLE. Most SCLE patients have anti-Ro antibodies. Local therapy is usually unsuccessful, and most patients require treatment with aminoquinoline antimalarials. Low-dose therapy with oral glucocorticoids is sometimes necessary; photoprotective measures against both ultraviolet B and A wavelengths are very important.