Lupus Erythematosus

Lupus is an autoimmune disorder that occurs when the body's immune system attacks its own tissues and organs. The inflammation in lupus can affect many body systems, including the joints, skin, blood, cells, heart, lungs, and kidneys. Lupus is often classified into four categories based on the time course of the disease, the body systems involved, and the types of skin lesions present.

Systemic Lupus Erythematosus (SLE)

SLE is the most common and serious form of lupus. It occurs more often in women than men and more often in blacks than whites. It involves both systemic and cutaneous symptoms. The disease may also be drug-induced by medications such as procainamide, hydralazine, and isoniazid.

Subacute Cutaneous Lupus Erythematosus (SCLE)

SCLE is a form of lupus only seen in the skin and rarely progresses to SLE. It is most common in young and middle-aged individuals. Females are affected more often than males.

Discoid Lupus Erythematosus (DLE)

DLE occurs commonly in the age range of 20 to 45 years. Females are affected more often than males. Blacks are affected more frequently than whites. For people with DLE, up to 5 percent will go on to develop SLE.

Lupus Panniculitis/Profundus

This type of lupus occurs in up to 35 percent of patients affected with at least a mild case of SLE and may also be associated with DLE.

Physical exam

Systemic Lupus Erythematosus

SLE may present with a wide variety of signs and symptoms. On the skin a red, butterfly-shaped rash (malar rash) on the face that covers the cheeks and bridge of the nose is often seen. Other red scaly skin lesions can be seen on exposed areas and worsen with sun exposure. Patients may also have fatigue, joint pain and stiffness, mouth sores, hair loss (alopecia), shortness of breath, chest pain, dry eyes, easy bruising, and fingers and toes that turn white or blue when exposed to cold (Raynaud's phenomenon).

Subacute Cutaneous Lupus Erythematosus

SCLE is a skin-limited form of lupus that may present with red, oval, mildly scaly skin lesions that are most commonly located in sun-exposed areas. The lesions are usually made worse by sun exposure. Some patients may have joint pains, but rarely have arthritis. About 10-15% of patients with SCLE will develop SLE with more severe symptoms.

Discoid Lupus Erythematosus

In DLE, early lesions appear as sharply defined, red or purple, scaly papules or plaques. Late lesions present as indented lesions with raised red or darkened borders, small dilated blood vessels, and variable loss of skin pigment (color). These late lesions often contain plugged follicles and eventually result in scar formation. Lesions are most commonly seen on the head and neck. About 5% of patients with DLE can progress to SLE. If DLE lesions are seen both above and below the neck, there is an increased risk of developing SLE with more severe symptoms.

Lupus Panniculitis/Profundus

This form of lupus involves the deeper layers of the skin and fat and can cause firm nodules on the face, scalp, breasts, upper arms, and buttocks. The overlying skin may appear normal or can be reddened.

Treatment

• Oral corticosteroids
• Topical or intralesional injections of corticosteroids
• Sunscreens
• Anti-malarial medications (Plaquenil)
• Immunosuppressive medications such as azathioprine (Imuran), cyclophosphamide (Cytoxan), mocyphenolate mofetil (CellCept)
• Retinoids
• Henry Ford Medical Dermatology