Subacute cutaneous lupus erythematosus lesions progressing to morphea

Hair and Scalp Changes in Cutaneous and Systemic Lupus Erythematosus

Cutaneous and systemic lupus erythematosus (SLE) commonly involves the hair and scalp. Alopecia can result from direct activity of disease on the scalp or from the state of physical stress in the form of telogen effluvium. Discoid lupus erythematosus and lupus panniculitis/profundus are known to cause scarring alopecia, while accumulation of recent studies has shown that non-scarring alopecia in SLE may have different subtypes, comprising lupus erythematosus-specific and lupus erythematosus-nonspecific changes on histology. This review aims to summarize the clinical pattern, trichoscopic, histopathological, and direct immunofluorescence features of different types of alopecia in cutaneous and systemic lupus erythematosus, as well as exploring their relationship with SLE disease activity.

Kutaner Lupus erythematodes

Cutaneous lupus erythematosus (CLE) is a heterogenous disorder with a wide range of skin manifestations. Therefore, it has been difficult to develop a unifying concept for classifying CLE from the dermatologic perspective in the past. In 2004, the classification system was updated and includes now acute CLE (ACLE), subacute CLE (SCLE), chronic CLE (CCLE), and intermittent CLE (ICLE). Additional rarely described variants are not listed as separate entities but are included in the classical forms. Diagnosis of the different subtypes of CLE is made by considering genetic, clinical, histopathologic, and immunoserologic findings, with a systematic analysis of individual criteria. In the past years, the etiology and pathogenesis of CLE has been subject of intensive research and it has been shown by several groups that exogenous factors, such as ultraviolet light and drugs, can induce CLE. The first part of this review will enable the reader to identify the various clinical manifestations of CLE and to employ characteristic criteria to assess differential diagnostic considerations.

Subacute cutaneous lupus erythematosus

Gilliam recognized subacute cutaneous lupus erythematosus (SCLE) as a lupus-specific eruption that identifies a unique subset of lupus erythematosus. These patients were noted to have prominent photoaggravated skin disease and often had musculoskeletal complaints, but generally did not develop significant systemic disease. SCLE patients were later found to have other distinctive features, including the frequent presence of anti-Ro antibodies, and enrichment for the human histocompatibility antigens (HLA) B8 and DR3. In the 13 years of published reports of SCLE patients following the initial study by Sontheimer et al (Subacute cutaneous lupus erythematosus: a cutaneous marker for a distinct lupus erythematosus subset. Arch Dermatol 115:1409-1415, 1979) a number of additional observations regarding SCLE patients have been made. These have included the recognition that SCLE may be associated with other rheumatic diseases, and that photoactive medications may induce lesions of SCLE. Areas of controversy concerning SCLE include conflicting studies regarding the histopathology of SCLE as compared to discoid lupus erythematosus (DLE), as well as the frequency of detection of anti-Ro antibodies in SCLE patients. Recent interesting studies of SCLE include a description of a unique pattern of immunoglobulin G (IgG) deposition on direct immunofluorescence, which may indicate the binding of anti-Ro antibodies to keratinocytes in vivo.