Cutaneous lupus erythematosus manifesting as unilateral eyelid erythema and swelling

Discoid lupus erythematosus solely involving the eyelids: case report and literature review

BACKGROUND AND OBJECTIVE

The involvement of eyelids occurs in only 5-6% of patients with discoid lupus erythematosus (DLE), commonly with mucocutaneous lesions elsewhere. DLE solely involving the eyelids is relatively rare. This study aimed to describe the clinical features and treatments of all the reported cases of DLE with eyelid involvement as the only symptom.

METHODS

A systematic review was done of all the related literature published both in English and Chinese from May 1, 1984, to March 1, 2020. Only those cases of DLE solely involving eyelids were selected and summarized in two tables.

RESULTS

(i) DLE solely involving the eyelids is five times more likely to affect females than males. (ii) The majority of cases were presenting with unilateral eyelid involvement. Lower lids, especially both lower lids, were the most commonly affected locations. (iii) An erythematous plaque with scales is the most frequent manifestation. (iv) Approximately 22.9% of the cases had a positive antinuclear antibody (ANA) titer, and the speckled pattern was the most seen. For direct immunofluorescence (DIF), 94.4% of the performed cases showed positive results. (v) More than 85% of these cases showed an excellent response to treatment with oral antimalarials.

CONCLUSION

Awareness of this atypical presentation is important to avoid underdiagnosis of DLE solely involving the eyelids. A biopsy for both routine histology and DIF is critical for establishing the diagnosis.

Periorbital erythema and swelling as a presenting sign of lupus erythematosus in tertiary referral centers and literature review

Background Cutaneous lupus erythematosus (CLE) includes a broad range of dermatologic manifestations. Periorbital involvement, however, is a relatively rare clinical presentation of CLE. Objectives This clinical study aimed to investigate the characteristics of this unique presentation of CLE in tertiary medical centers. Methods We enrolled patients with periorbital erythema and swelling as the presenting sign of lupus erythematosus, from January 2003 to November 2017, using the data of 553 pathologically proven CLE cases from the registration database of the Chang Gung Memorial Hospitals in Taiwan. Results We enrolled a total of 25 patients. The mean age was 46.7 years and 68% of the patients were female. Most of the patients (84.0%) presented with unilateral involvement, with the left orbit involved in 15 patients (60%); the upper eyelid was the most frequently involved (72%). Mean duration between the onset of clinical manifestations and the diagnosis of CLE was approximately 59 weeks. Nineteen patients had been previously misdiagnosed. All patients had features compatible with CLE on histopathological examination. In contrast, laboratory analysis of the autoimmune profile often revealed negative results, including those for antinuclear antibodies (25%). Notably, anti-SSA/SSB (45.5%) showed the highest positive rate. During follow-up, six patients developed systemic lupus erythematosus (SLE) and two patients developed Sjögren syndrome. Conclusions The diagnosis of CLE presenting as periorbital erythema and swelling is often delayed because of clinical mimicry and the high proportion of negative results on autoantibody tests. Increased clinical suspicion and prompt histopathological examination are crucial for early diagnosis. Moreover, one-fourth of the patients ultimately developed SLE, which highlights the importance of clinical awareness.