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Cutaneous sequelae in neonatal lupus: A retrospective cohort study. J Am Acad Dermatol 2020; 83:440-446. [DOI: 10.1016/j.jaad.2019.09.083] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 09/11/2019] [Accepted: 09/27/2019] [Indexed: 11/18/2022]
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Barsalou J, Costedoat-Chalumeau N, Berhanu A, Fors-Nieves C, Shah U, Brown P, Laskin CA, Morel N, Levesque K, Buyon JP, Silverman ED, Izmirly PM. Effect of in utero hydroxychloroquine exposure on the development of cutaneous neonatal lupus erythematosus. Ann Rheum Dis 2018; 77:1742-1749. [PMID: 30297329 PMCID: PMC6382275 DOI: 10.1136/annrheumdis-2018-213718] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2018] [Revised: 08/07/2018] [Accepted: 08/07/2018] [Indexed: 01/14/2023]
Abstract
OBJECTIVE Cutaneous neonatal lupus (cNL) occurs in possibly 5%-16% of anti-Ro±anti-La antibody-exposed infants. Data suggest in utero exposure to hydroxychloroquine (HCQ) may prevent cardiac NL. The aim was to assess whether in utero exposure to HCQ decreases the risk of cNL and/or delays onset. METHODS A multicentre case-control study was performed with 122 cNL cases and 434 controls born to women with a rheumatological disease who had documentation of maternal anti-Ro±anti-La antibodies at pregnancy and confirmation of medication use and the child's outcome. A secondary analysis was performed on 262 cNL cases, irrespective of maternal diagnosis, to determine if HCQ delayed time to cNL onset. RESULTS Twenty (16%) cNL cases were exposed to HCQ compared with 146 (34%) controls (OR 0.4 (95% CI 0.2 to 0.6); p<0.01). Exposure to HCQ was associated with a reduced risk of cNL; exposure to anti-La antibody and female gender were associated with an increased risk of cNL. Exposure to HCQ remained significantly associated with a reduced cNL risk in the analyses limited to mothers with systemic lupus erythematosus and those who developed rash ≤1 month. When analysing all 262 cNL cases, HCQ-exposed infants were older (6.0 (95% CI 5.7 to 6.3) weeks) at cNL onset versus HCQ-non-exposed infants (4.4 (95% CI 3.9 to 5.0) weeks), but the difference was not statistically significant (p=0.21). CONCLUSION Exposure to HCQ was associated with a reduced risk of cNL. Among cNL cases, those exposed to HCQ tend to have later onset of rash. Both findings suggest a protective effect of HCQ on cNL.
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Affiliation(s)
- Julie Barsalou
- Division of Rheumatology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Nathalie Costedoat-Chalumeau
- Department of Internal Medicine, Cochin Hospital, Centre de Référence Maladies Auto-Immunes et Systémiques Rares, AP-HP, Université Paris Descartes-Sorbonne Paris Cité, Paris, France
| | - Adey Berhanu
- Arthritis & Rheumatism Associates, PS Wheaton, Maryland, USA
| | - Cesar Fors-Nieves
- Division of Rheumatology, New York University School of Medicine, New York City, New York, USA
| | - Ummara Shah
- Division of Allergy, Immunology and Rheumatology, University of Rochester, School of Medicine and Dentistry, Rochester, USA
| | - Patrick Brown
- Department of Statistical Science, University of Toronto, Centre for Global Health Research, St Michael's Hospital, Toronto, Ontario, Canada
| | - Carl A Laskin
- Department of Medicine, Obstetrics and Gynaecology, University of Toronto, TRIO Fertility, Toronto, Ontario, Canada
| | - Nathalie Morel
- Department of Internal Medicine, Cochin Hospital, Centre de Référence Maladies Auto-Immunes et Systémiques Rares, AP-HP, Université Paris Descartes-Sorbonne Paris Cité, Paris, France
| | - Kateri Levesque
- Department of Internal Medicine, Cochin Hospital, Centre de Référence Maladies Auto-Immunes et Systémiques Rares, AP-HP, Université Paris Descartes-Sorbonne Paris Cité, Paris, France
| | - Jill P Buyon
- Division of Rheumatology, New York University School of Medicine, New York City, New York, USA
| | - Earl D Silverman
- Division of Rheumatology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Peter M Izmirly
- Division of Rheumatology, New York University School of Medicine, New York City, New York, USA
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Rotstein Grein IH, Armbrust W, van der Molen AM, van Royen-Kerkhof A. Juvenile idiopathic arthritis in a patient with previous diagnosis of severe congenital lupus. Lupus 2017. [PMID: 28649905 DOI: 10.1177/0961203317709345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Neonatal lupus (NL) is an acquired autoimmune disease of the newborn, caused by transplacental passage of the maternal autoantibodies anti SS-A/Ro and anti SS-B/La. When the clinical picture starts directly at birth, it is known as congenital lupus (CL). The clinical manifestations are variable. Except for cardiac involvement, the other manifestations tend to be benign, and resolve with the child's clearance of maternal antibodies. We report a patient who presented at birth with very severe involvement of the skin, and subsequent contractures of hands and feet, leading to functional impairment. The patient underwent surgical procedures with excellent result. At the age of 18 months, the patient was diagnosed with oligoarticular juvenile idiopathic arthritis (JIA), and bilateral uveitis at the age of 3 years and a half. Our aim is to alert health professionals about the possibility of a severe course of cutaneous manifestations in CL, as well as the role of CL and NL regarding development of other autoimmune diseases.
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Affiliation(s)
- I H Rotstein Grein
- 1 Department of Pediatrics, Wilhelmina Children's Hospital/University Medical Centre Utrecht, Utrecht, the Netherlands.,2 Department of Pediatric Rheumatology, Hospital Pequeno Príncipe, Curitiba, Paraná, Brazil
| | - W Armbrust
- 3 Department of Pediatrics, University Medical Centre Groningen, Groningen, the Netherlands
| | - A M van der Molen
- 4 Department of Surgery, Wilhelmina Children's Hospital/University Medical Centre Utrecht, Utrecht, the Netherlands
| | - A van Royen-Kerkhof
- 1 Department of Pediatrics, Wilhelmina Children's Hospital/University Medical Centre Utrecht, Utrecht, the Netherlands
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Abstract
We describe a case of neonatal lupus erythematosus in a term female infant who presented at birth with mild, scattered facial erythema and ice-pick lesions at lateral and superior borders of her face. These lesions then progressed to an erythematous raccoon-like mask following exposure to the sun. Initial blood work performed at four-months-old showed speckled anti-nuclear antibody titers of 1:320, with negative anti-Ro/SSA and La/SSB negative and a positive anti-RNP. The infant had no evidence of cardiac, haematological or hepatobilary involvement initially or throughout her course of evaluation. The patient’s mother was asymptomatic throughout the investigation of the infant but through blood work and evolvement of symptoms, she was diagnosed with mixed connective tissue disease.
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Affiliation(s)
- C McGeachy
- Primary Care Nurse Practitioner, Clinical Nursing Professor, McMaster University, Hamilton, Ontario, Canada
| | - J Lam
- Staff physician, Pediatric Allergy and Dermatology Clinic, Vancouver, British Columbia, Canada
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Peñate Y, Luján D, Rodríguez J, Hernández-Machín B, Montenegro T, Afonso JL, Borrego L. [Neonatal lupus erythematosus: 4 cases and clinical review]. ACTAS DERMO-SIFILIOGRAFICAS 2006; 96:690-6. [PMID: 16476322 DOI: 10.1016/s0001-7310(05)73160-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Neonatal lupus erythematosus (NLE) is an infrequent disease in newborns caused by the transplacental passage of maternal Anti-Ro/SSA, Anti-La/SSB and/or Anti-U1 RNP antibodies. The most common manifestations are cutaneous and cardiac. We carried out a retrospective study of cases of NLE diagnosed in the last 10 years at the Hospital Universitario Insular in Gran Canaria. Complete data was obtained for 4 patients. Three cases had circulating Anti-Ro antibodies in the mother and in the newborns, while in the fourth case they were Anti-RNP. Two mothers were diagnosed with systemic lupus, one with mixed connective tissue disease and the other with leucocytoclastic vasculitis. The skin lesions consisted of urticaria-like and desquamative lesions. One patient presented with ulceration. The histological study of the urticaria-like lesions showed a non-specific perivascular infiltrate; the desquamative lesions were consistent with subacute lupus erythematosus.
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Affiliation(s)
- Yeray Peñate
- Servicio de Dermatología, Hospital Universitario Insular, Las Palmas de Gran Canaria, Spain.
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Grimes P, Nordlund JJ, Pandya AG, Taylor S, Rendon M, Ortonne JP. Increasing our understanding of pigmentary disorders. J Am Acad Dermatol 2006; 54:S255-61. [PMID: 16631966 DOI: 10.1016/j.jaad.2005.12.042] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
This article focuses on developments in pigmentary disorders that extend dermatologists' understanding of the field. Areas that are reviewed include the basic biochemistry, pharmacology, and physiology of the melanocortin system; melanosome development; genetic diseases associated with pigmentary disorders; pigmentary disorders secondary to systemic disease; drug-induced hyperpigmentation; environmental exposure to chemicals; and primary disorders of hyperpigmentation such as melasma and lentigines. Basic, clinical, and epidemiological research, along with a number of clinical case reports, were included in the review. This article also reports on the new health-related quality-of-life instrument (MELASQOL) that has been developed for women with melasma.
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Affiliation(s)
- Pearl Grimes
- Vitiligo & Pigmentation Institute of Southern California, Division of Dermatology, University of California, Los Angeles, CA, USA
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Abstract
Lupus erythematosus is the great imitator of other diseases. There is a broad range of cutaneous symptoms induced by lupus or by its various treatments. This article provides a short overview of uncommon presentations of cutaneous symptoms in the lupus spectrum.
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Affiliation(s)
- Uwe Wollina
- Department of Dermatology, Academic Teaching Hospital Dresden-Friedrichstadt, 01067 Dresden, Germany.
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