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Toyama T, Miyagawa T, Sato S, Asano Y. Linear childhood discoid lupus erythematosus along a Blaschko's line of the arm. JOURNAL OF CUTANEOUS IMMUNOLOGY AND ALLERGY 2021. [DOI: 10.1002/cia2.12221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Tetsuo Toyama
- Department of Dermatology University of Tokyo Graduate School of Medicine Bunkyo‐ku Japan
- Department of Dermatology International University of Health and Welfare Narita‐shi Japan
| | - Takuya Miyagawa
- Department of Dermatology University of Tokyo Graduate School of Medicine Bunkyo‐ku Japan
| | - Shinichi Sato
- Department of Dermatology University of Tokyo Graduate School of Medicine Bunkyo‐ku Japan
| | - Yoshihide Asano
- Department of Dermatology University of Tokyo Graduate School of Medicine Bunkyo‐ku Japan
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Lim D, Hatami A, Kokta V, Piram M. Linear cutaneous lupus erythematosus in children-report of two cases and review of the literature: A case report. SAGE Open Med Case Rep 2020; 8:2050313X20979206. [PMID: 33343900 PMCID: PMC7731695 DOI: 10.1177/2050313x20979206] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 10/22/2020] [Indexed: 11/17/2022] Open
Abstract
Linear cutaneous lupus erythematosus is an unusual presentation of cutaneous lupus following Blaschko’s lines. It is described mostly in children and young adults and is usually not associated with systemic involvement. We report two cases of linear cutaneous lupus erythematosus in children who significantly improved after treatment with hydroxychloroquine in combination with topical corticosteroids and tacrolimus. These rare cases underline the importance of including linear cutaneous lupus erythematosus in the differential diagnosis of blaschkoid inflammatory lesions.
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Affiliation(s)
- Darosa Lim
- Division of Pediatric Dermatology, Centre Hospitalier Universitaire Sainte-Justine, University of Montreal, Montreal, QC, Canada
| | - Afshin Hatami
- Division of Pediatric Dermatology, Centre Hospitalier Universitaire Sainte-Justine, University of Montreal, Montreal, QC, Canada
| | - Victor Kokta
- Department of Anatomopathology, Centre Hospitalier Universitaire Sainte-Justine, University of Montreal, Montreal, QC, Canada
| | - Maryam Piram
- Division of Pediatric Dermatology, Centre Hospitalier Universitaire Sainte-Justine, University of Montreal, Montreal, QC, Canada.,CHU Sainte Justine Research Center, University of Montreal, QC, Canada.,Université Paris-Saclay, Centre de Recherche en épidémiologie et Santé des populations (CESP), Le Kremlin-Bicêtre, France
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Yu S, Yu HS. A patient with subacute cutaneous lupus erythematosus along Blaschko lines: Implications for the role of keratinocytes in lupus erythematosus. DERMATOL SIN 2016. [DOI: 10.1016/j.dsi.2015.12.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Marinho AKDOF, Ramos TB, Barbosa DMDC, Kozmhinsky V, Takano DM, Figueira MMDSA. Linear cutaneous lupus erythematosus following the lines of Blaschko - Case report. An Bras Dermatol 2016; 91:510-3. [PMID: 27579750 PMCID: PMC4999113 DOI: 10.1590/abd1806-4841.20163800] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2014] [Accepted: 12/15/2014] [Indexed: 11/22/2022] Open
Abstract
Chronic cutaneous lupus erythematosus in a linear configuration is rare, particularly in children, demonstrating similar incidence in both genders, no photo-sensitivity and lower probability of progression to systemic disease. We describe the case of a 9-year-old girl who presented erythematous papules with central atrophy on the upper and lower right limbs, asymptomatic and following the lines of Blaschko, since age four. Histological examination showed atrophy of the epidermis with aggression from epidermal-dermal interface and periadnexal and perivascular lymphocytic inflammatory infiltrate. Laboratory tests showed ANA in a titer of 1:320, in a dense and fine speckled pattern. Due to the rarity of presentation and location of the disease, this case is reported here.
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Affiliation(s)
| | | | | | - Valter Kozmhinsky
- Instituto de Medicina Integral Professor Fernando Figueira (Imip) - Recife (PE), Brazil
| | - Daniela Mayumi Takano
- Instituto de Medicina Integral Professor Fernando Figueira (Imip) - Recife (PE), Brazil
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Jin H, Zhang G, Zhou Y, Chang C, Lu Q. Old lines tell new tales: Blaschko linear lupus erythematosis. Autoimmun Rev 2016; 15:291-306. [DOI: 10.1016/j.autrev.2015.11.014] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Accepted: 11/26/2015] [Indexed: 12/11/2022]
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Frances L, Betlloch I, Leiva-Salinas M, Marin I, Pascual JC. Subacute cutaneous lupus erythematosus starting as linear lupus erythematosus. Int J Dermatol 2015; 55:173-6. [PMID: 26235783 DOI: 10.1111/ijd.12829] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2014] [Revised: 07/15/2014] [Accepted: 07/22/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND Cutaneous lupus in childhood is usually associated with systemic lupus erythematosus (LE). Linear cutaneous LE (LCLE) is an unusual presentation mostly seen in children and young adults. METHODS We report a rare case of cutaneous subacute LE with a segmentary pattern following the lines of Blaschko in an 18-month-old girl with a 2-month history of persistent, linear, asymptomatic, erythematous lesions along the right arm. The clinical diagnosis at presentation was lichen striatus. RESULTS A biopsy showed an intense, band-like, inflammatory cell infiltrate with perivascular and periadnexal involvement associated with basal cell liquefactive degeneration. The lesions were treated with topical corticosteroids and healed without scarring. Two months later, new lesions manifested as multiple erythematous, edematous, polycyclic plaques. A new biopsy showed a periadnexal infiltrate, a large amount of mucin, and a thickened basement membrane. Direct immunofluorescence was negative. Our definitive diagnosis was subacute cutaneous LE starting as linear LE. The lesions responded slowly to oral corticosteroids. Six months later, only a mild livedoid skin pattern remained on the patient's legs. CONCLUSIONS Linear cutaneous LE usually presents with erythematous, atrophic, hyperkeratotic, dyschromic circular lesions arranged in a linear pattern; the main differential diagnosis is lichen striatum. In general, LCLE can be considered as discoid lupus following Blaschko's lines, which correspond to the direction of growth in clones of cutaneous cells that arise during embryogenesis. The present patient represents the first pediatric case of subacute cutaneous LE following Blaschko's lines, with posterior progression to a generalized form of subacute LE.
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Affiliation(s)
- Laura Frances
- Department of Dermatology, General University Hospital of Alicante, Alicante, Spain
| | - Isabel Betlloch
- Department of Dermatology, General University Hospital of Alicante, Alicante, Spain
| | - Maria Leiva-Salinas
- Department of Dermatology, General University Hospital of Alicante, Alicante, Spain
| | - Irene Marin
- Department of Dermatology, General University Hospital of Alicante, Alicante, Spain
| | - Jose Carlos Pascual
- Department of Dermatology, General University Hospital of Alicante, Alicante, Spain
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Tsuzaka S, Ishiguro N, Akashi R, Kawashima M. A case of lupus erythematosus profundus with multiple arc-shaped erythematous plaques on the scalp and a review of the literature. Lupus 2012; 21:662-5. [PMID: 22247340 DOI: 10.1177/0961203311433917] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
A 26-year-old Japanese female presented to us with a 2-year history of multiple arc-shaped erythematous lesions on her scalp and the right side of her forehead. Histopathological examination of two of the lesions showed lobular and septal panniculitis with deposits of IgG in the basement membrane zone. We diagnosed the case as lupus erythematosus profundus, and successfully treated her with 20 mg/day prednisolone. To our knowledge, there has been only one previously reported case of lupus erythematosus profundus with annular-shaped erythematous lesions and six cases with linear configuration.
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Affiliation(s)
- S Tsuzaka
- Department of Dermatology, Tokyo Women's Medical University, Japan.
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Daldon PEC, Lage R. Linear chronic discoid lupus erythematosus following the lines of Blaschko. An Bras Dermatol 2011; 86:553-6. [PMID: 21738975 DOI: 10.1590/s0365-05962011000300020] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2009] [Accepted: 05/13/2010] [Indexed: 11/21/2022] Open
Abstract
Linear chronic discoid lupus erythematosus is a rare manifestation of cutaneous lupus in which erythematous, atrophic, dyschromic lesions are located along the lines of Blaschko. This report describes the case of a 15-year old boy with a 2-year history of discoid, erythematous, hyper and hypopigmented lesions with central atrophy, situated along the lines of Blaschko on his right arm. Histopathology showed epidermal atrophy, hyperkeratosis, follicular plugging, thickening of the basement membrane zone, and superficial and deep chronic perivascular and periadnexal inflammatory infiltrate, with dermal mucin deposit, thus confirming diagnosis. A total of 14 cases have been described of this variant, the onset of which is often in childhood. There is no difference in incidence between genders. Lesions most commonly develop on the face. There have been no reports of any association with systemic disease.
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Imhof L, Kerl K, Barysch MJ, Dummer R, French LE, Hofbauer GFL. Facial blaschkitis: case and review. Dermatology 2011; 223:1-3. [PMID: 21625075 DOI: 10.1159/000328136] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2010] [Accepted: 04/02/2011] [Indexed: 11/19/2022] Open
Abstract
We report on a 15-year-old female with a 3-month history of a pruritic, erythematous cutaneous eruption on the right cheek and perioral area. The lesion had a linear distribution following the lines of Blaschko. Histopathological findings and direct immunofluorescence were compatible with chronic cutaneous lupus erythematosus (LE). Treatment with topical steroids and systemic antimalarial agents over 2 months showed hardly any improvement contrary to similar cases reported in the literature in the past. Histological findings move this case close to LE. However, the unusual clinical presentation as well as the resistance to antimalarial drugs do not fully allow to confirm this suspicion. Therefore, we recommend to call this new entity LE-like facial Blaschkitis of the adult.
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Affiliation(s)
- Laurence Imhof
- Department of Dermatology, University Hospital, Zurich, Switzerland.
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Obermoser G, Sontheimer RD, Zelger B. Overview of common, rare and atypical manifestations of cutaneous lupus erythematosus and histopathological correlates. Lupus 2010; 19:1050-70. [PMID: 20693199 DOI: 10.1177/0961203310370048] [Citation(s) in RCA: 123] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
The skin is the second most frequently affected organ system in lupus erythematosus. Although only very rarely life threatening--an example is lupus erythematosus-associated toxic epidermal necrolysis--skin disease contributes disproportionally to disease burden in terms of personal and psychosocial wellbeing, vocational disability, and hence in medical and social costs. Since several manifestations are closely associated with the presence and activity of systemic lupus erythematosus, prompt and accurate diagnosis of cutaneous lupus erythematosus is essential. This review aims to cover common, rare, and atypical manifestations of lupus erythematosus-associated skin disease with a detailed discussion of histopathological correlates. Cutaneous lupus erythematosus covers a wide morphological spectrum well beyond acute, subacute and chronic cutaneous lupus erythematosus, which are commonly classified as lupus-specific skin disease. Other uncommon or less well-known manifestations include lupus erythematosus tumidus, lupus profundus, chilblain lupus, mucosal lupus erythematosus, and bullous lupus erythematosus. Vascular manifestations include leukocytoclastic and urticarial vasculitis, livedoid vasculopathy and livedo reticularis/ racemosa. Finally, we discuss rare presentations such as lupus erythematosus-related erythema exsudativum multiforme (Rowell syndrome), Kikuchi-Fujimoto disease, extravascular necrotizing palisaded granulomatous dermatitis (Winkelmann granuloma), and neutrophilic urticarial dermatosis.
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Affiliation(s)
- G Obermoser
- Baylor Institute for Immunology Research, Dallas, TX, USA.
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Seitz CS, Bröcker EB, Trautmann A. Linear variant of chronic cutaneous lupus erythematosus: a clue for the pathogenesis of chronic cutaneous lupus erythematosus? Lupus 2009; 17:1136-9. [PMID: 19029283 DOI: 10.1177/0961203308092425] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Lesions of chronic cutaneous lupus erythematosus usually occur in a discoid pattern as erythematous, well-defined, scaly patches affecting face and scalp. The linear variant of chronic cutaneous lupus erythematosus is an exceptional clinical variation with band-like arranged lesions along the lines of Blaschko which represent the developmental growth pattern of embryonic ectodermal cells. Therefore, this unusual clinical observation may provide additional clues for the pathogenesis of chronic cutaneous lupus erythematosus. It is intriguing to hypothesize that linear lesions of chronic cutaneous lupus erythematosus may be caused by increased susceptibility of resident skin cells due to mutations of genes in early embryogenesis.
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Affiliation(s)
- C S Seitz
- Department of Dermatology, Venereology and Allergology, University of Würzburg, Würzburg, Germany.
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Happle R. Superimposed segmental manifestation of polygenic skin disorders. J Am Acad Dermatol 2007; 57:690-9. [PMID: 17870433 DOI: 10.1016/j.jaad.2007.06.039] [Citation(s) in RCA: 71] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2007] [Revised: 05/01/2007] [Accepted: 06/29/2007] [Indexed: 10/22/2022]
Abstract
In common acquired skin disorders with a polygenic background such as psoriasis, a linear or otherwise segmental arrangement may sometimes be noted. The segmental involvement tends to be rather severe and may be associated with milder, nonsegmental lesions of the same disorder. Such cases may be best explained by an early postzygotic event in the form of loss of heterozygosity involving one of the genes that predispose to the disorder. The following pertinent examples are reviewed in this article: psoriasis vulgaris, pustular psoriasis, atopic dermatitis, lichen planus, systemic lupus erythematosus, pemphigus vulgaris, vitiligo, graft-versus-host disease, granuloma annulare, erythema multiforme, and drug eruption to ibuprofen. Such cases should not be categorized as a "type 2 segmental manifestation" because this term exclusively applies to monogenic traits, whereas in polygenic disorders the more descriptive term "superimposed segmental manifestation" seems appropriate. The concept of early loss of heterozygosity offers a plausible explanation as to why: the segmental involvement tends to appear at a rather young age and often precedes the development of milder, nonsegmental lesions of the same disorder; the segmental lesions are notoriously difficult to treat; and family members may show the disorder in its nonsegmental form. On the other hand, the theory of isolated versus superimposed segmental manifestation may help to elucidate the origin of polygenic skin disorders at the molecular level.
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Affiliation(s)
- Rudolf Happle
- Department of Dermatology, Philipp University of Marburg, Marburg, Germany.
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Abstract
Eleven patients with linear cutaneous lupus erythematosus following the lines of Blaschko have been previously reported in the literature. We describe a child with this entity following Blaschko lines on the trunk. The patient responded to oral hydroxychloroquine therapy combined with topical flurandrenolide tape resulting in resolution with atrophic scarring. The clinical and histological features of linear cutaneous lupus erythematosus are discussed and a review of the literature is presented.
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Affiliation(s)
- Dendy E Engelman
- Department of Dermatology, Medical University of South Carolina, Charleston, South Carolina, USA
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Abstract
We report a case of lichen striatus in a 37-year-old woman in the third trimester of pregnancy. She presented at 35 weeks of pregnancy with a 6-week history of a pruritic rash on the left side of her abdomen. Examination revealed an erythematous papular eruption arranged in a linear fashion from the umbilicus to the left mid back. Histological examination demonstrated lichenoid perivascular and periadnexal inflammatory infiltrate and the presence of colloid bodies. The eruption resolved prior to delivery with the application of mometasone furoate 0.1% ointment.
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Affiliation(s)
- Sarah Brennand
- Department of Medicine (Dermatology), St Vincent's Hospital, Melbourne, Victoria, Australia
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Marzano AV, Tanzi C, Caputo R, Alessi E. Sclerodermic Linear Lupus Panniculitis: Report of Two Cases. Dermatology 2005; 210:329-32. [PMID: 15942222 DOI: 10.1159/000084760] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2004] [Accepted: 09/13/2004] [Indexed: 11/19/2022] Open
Abstract
Lupus erythematosus panniculitis is a rare disease characterized by deep subcutaneous nodules, most commonly localized on the upper limbs and face. Unique clinical presentations, such as linear configuration or 'overlap' forms between lupus erythematosus panniculitis and localized scleroderma have been reported. We present here the clinical characteristics, course and laboratory findings of 2 patients having linear lupus erythematosus panniculitis with localized scleroderma-like changes. The 2 patients (of the 14 patients with lupus erythematosus panniculitis seen by us since 1990) were females with a young age at the onset of disease (median, 25 years). In 1 case, evolution into systemic lupus erythematosus with severe renal involvement occurred whereas the other patient, who had a spontaneous abortion and exhibited anticardiolipin antibodies, should be followed and screened for the emergence of antiphospholipid syndrome. Thus, the clinical behavior of this variant seems to be more aggressive, as compared with the usual course of lupus erythematosus panniculitis, which is considered to be a benign disease, although some reports have suggested that its prognosis is not always favorable. The linear distribution could be the clinical hallmark of such a unique, 'sclerodermic' subset of lupus erythematosus panniculitis.
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Affiliation(s)
- A V Marzano
- Institute of Dermatological Sciences of the University of Milan and IRCCS Ospedale Maggiore of Milan, Milan, Italy.
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