cutaneous lupus erythematosus (LE).
cutaneous lupus erythematosus (LE).
Cutaneous LE can be observed independently or concomitant with SLE. Cutaneous LE includes 3 subsets of LE-specific skin disorders: acute cutaneous LE (ACLE), subacute cutaneous LE (SCLE), and chronic cutaneous LE (CCLE). A variety of non-LE cutaneous disorders can be observed in ptns with SLE (LE-nonspecific skin diseases). Subtypes of LE-specific skin disease have been associated with SLE with variable strengths. Whilst ACLE is almost always observed in association with SLE, other sub-types of lupus-specific skin disease are less often observed with SLE.
ACLE can be observed as a local, generalized, or toxic epidermal necrolysis-like eruption. The most common observed manifestation is the 👉 localized facial eruption (malar rash, butterfly rash) that’s characterized by the developing of erythema over the cheeks & nasal bridge. ACLE may persist for hours, days, or weeks and usually recurrent. SCLE may present as an idiopathic eruption associated with SLE, or as a drug-induced disease. SCLE typically seen as psoriasiform or annular erythematous plaques on the shoulders, forearms, neck, or upper torso. There’s a strong correlation with Ro/SSA auto-AB. A possible aetiology of a drug-induced SCLE should considered, particularly with intense or universal skin affection.
Discoid lupus erythematosus (DLE) is the 👉 most commonly observed form of CCLE. Ptns with DLE may show erythematous, scaly plaques that exhibits follicular plugging & often heal with scarring. Lesion with hypopigmentation & hyperpigmentation are commonly seen frequently in the face, neck, scalp, & ears. Ptns with the generalized variant of DLE may show affection of the trunk or extremities. A hypertrophic variant of DLE is observed with hyperkeratotic, verrucous plaques. LE tumidus, lupus profundus, chilblain LE, and lichenoid cutaneous LE-lichen planus overlap syndrome are additional subtypes of CCLE. Cutaneous LE is a clinical Dgx to a large extent that is supported by contextual clinical criteria (e.g. presence of known underlying SLE). Confirmatory histopathologic testing is indicated if diagnosis is doughty persisting. In selected ptns with known SLE and/or typical clinical criteria of cutaneous LE, lesion biopsy may not be required.
A given approach to manage cutaneous LE is usually tailored according to disease severity, subtype of the cutaneous LE, response to initial therapy & the presence of underlying SLE. Photoprotection, topical steroids, topical CNI, & oral antimalarials are currently the 1st-line therapy. LE can affect mucous membranes. Oral involvement can be manifested as white plaque, erythema, erosion, or ulcers. DD: Oral LE should be differentiated from lichen planus, candidiasis, aphthous stomatitis, intraoral herpes, Behçet syndrome, bite marks, leucoplakia, & malignancy.
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