Lupus erythematosus

Discoid lupus erythematosus

Systemic lupus erythematosus

Discoid Lupus erythematosus

Young adult
Women: men = 2:1
Clinnical Findings :
Dull red macule with adherent scale with
follicular plugging, which heal with atrophy,
scarring and pigemantary changing,
telangiekatasis.
Side: usually above the neck. Favorite are
scalp, bridges of the nose, malar areas,
lower lips and ears

Generalized dle is less common than

localized DLE and is usually
suerimposed on alocallized discoid
case.
Progression from DLE to systemic
lupus erythematosus (SLE) is
uncommon.

Differential diagnosis
Seborrheic dermatitis
Rosacea
Lupus vulagris
Sarcoid
Drug eruption

Treatment
Avoid exposure to sunlight, excessive
cold, to heat and trauma
Use a high SPF sun screen
Local:
potent or super potent corticosteroid
Intralesional triamsinolon acetonide 2,5 to
10 mg/ml

Systemic
Anti malarials. Hydroxychloroquine 6,5
mg/kg/day. Chloroquine 250 mg/day
Quinacrine
Systemic corticosteroid for widespread
or disfuguring lesion

Systemic Lupus Erythematosus

Young to middle aged women

Skin involvement occurs in 80% of
cases
Diagnosis of SLE are based on four of
the American Rheumatism
Assosiations 11 criteria

Cutaneus manifestation
Butterfly facial erythemmabullous lesion
Diffuse, non scarring hair loss
Mucous membrane lesion eq
conjunctivitis, episcleritis, vaginal ulcer
Leg ulcer
Cutaneous angiitis
Calcinosis cutis

Systemic manifestation

Arthralgia
Renal involvement
Myocarditis
CNS involvement
Vasculitis
Convulsion
Epilepsy
Retinitis
Idiopathic trombocytopenic purpura

Etiology
Genetic
Altered immune respon
Drugs such as hydralazine, procainamid,
sulfonamid, penicillin, anticonvulsan,
minocycline and isoniazid

Laboratory findings
Anemia hemolytic
Thrombocytopenia
Lymphopenia
Leukopenia
Erythrocyte sedimentation rate is
elevated
Coombs tes positif
Rgeumatoid factor positif

Immulogic findings
ANA test
LE cell test
Ds DNA
Anti SM antibody
Lupus band test
ANA pattern

Differential diagnosis
Dermtaomyositis
Toxic erytema multiforme
Acute rheumatoid fever
Drug eruption
Sjogrens syndrome

Treatment
Avoid exposure to sunlight and use a high SPF
sun screen
Antimalarial: hydroxychlotoquin or chloroquin
Corticosteroid: 1000 mg of prednisolone IV
daily for 3 days , followed bt oraal prednisone
0,5 to 1 mg/kg/dailly
Immunosuppressive therapy: azathiopreine,
methotrexate and cyclophosphamide

1982 ACR (Revised 1997) SLE

Classification Criteria
1.
2.
3.
4.
5.
6.
7.

8.
9.
10.

11.

Malar (butterfly) rash

Discoid lesions
Photosensitivity
Oral ulcers
Non-deforming arthritis (non-erosive for the most part)
Serositis: pleuropericarditis, aseptic peritonitis
Renal: persistent proteinuria 0.5 g/d or 3+ or cellular
casts
Neurologic disorders: seizures, psychosis
Heme: hemolytic anemia; leukopenia, thrombocytopenia
Immune: anti-DNA, or anti-Sm, or APS (ACA IgG, IgM),
or lupus anticoagulant (standard) or false + RPR
Positive FANA (fluorescent antinuclear antibody)

SLE-Clinical and Laboratory Features

Musculoskeletal 90%
Skin
80%
Renal 50%
CNS
15%
Severe thrombocytopenia
5-10%
Positive ANA
95+%

Also, cardiopulmonary involvement,

thrombotic tendency (APS), and
premature or accelerated
atherosclerosis!

Joint involvement in lupus mimics rheumatoid arthritis (RA) but milder

Jaccouds arthropathy

Arthritis in lupus can be

deforming but is typically
non-erosive!