Lupus erythematosus (LE) is the designation of a spectrum of diseases that are linked by distinct clinical findings and distinct patterns of polyclonal B cell immunity. It ranges from life-threatening manifestations of systemic lupus erythematosus (SLE) to the limited and exclusive skin involvement in chronic cutaneous lupus erythematosus (CCLE). More than 85% of patients with LE have skin lesions, which can be classified into LE-specific and -nonspecific. An abbreviated version of Gilliam’s classification of LE-specific lesions.
Systemic lupus erythematosus
This serious multisystem autoimmune disease is based on polyclonal B cell immunity which involves connective tissue and blood vessels. The clinical manifestations include fever (90%); skin lesions (85%); arthritis; CNS, renal, cardiac, and pulmonary disease. Systemic lupus erythematosus (SLE) may uncommonly develop in patients with chronic cutaneous lupus erythematosus (CCLE); however, lesions of CCLE are common in SLE.
Causes of Lupus Erythematosus
The tissue injury in the epidermis results from the deposition of immune complexes at the dermal-epidermal junction. Immune complexes selectively generate the assembly of the membrane-attack complex, which mediates membrane injury. CD3+ lymphocytes of the cytotoxic Suppressor type.
Symptoms of Lupus Erythematosus
- Skin rashes
- Discoid lupus with the red skin patches on the skin and scaliness is a special characteristic rash that can lead to scarring.
- Hair loss can occur with flares of SLE even without skin rashes in the scalp.
- Other common skin symptoms include skin sores or flaky red spots on the arms, hands, face, neck, or back; mouth or lip sores.
Diagnosis
Made on the basis of clinical findings, histopathology, lupus band test, and serology within the framework of the revised American Rheumatism Association (ARA) criteria for classification of SLE.
Treatment
General Measures Rest, avoidance of sun exposure.
Indications for Prednisone (60 mg/d in divided doses):
- CNS involvement
- renal involvement
- severely ill patients without CNS involvement
- hemolytic crisis.
Concomitant Immunosuppressive Drugs Azathioprine or cyclophosphamide, depending on organ involvement and activity of disease. In renal disease cyclophosphamide IV bolus therapy.
Antimalarials Hydroxychloroquine is useful for treatment of the skin lesions in subacute and chronic SLE, but does not reduce the need for prednisone. Observe precautions in the use of hydroxychloroquine.
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