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Daruish M, Ambrogio F, Foti C, Filosa A, Cazzato G. Tumid Lupus Erythematosus (TLE): A Review of a Rare Variant of Chronic Cutaneous Lupus Erythematosus (cCLE) with Emphasis on Differential Diagnosis. Diagnostics (Basel) 2024; 14:780. [PMID: 38611691 PMCID: PMC11011942 DOI: 10.3390/diagnostics14070780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Revised: 03/31/2024] [Accepted: 04/05/2024] [Indexed: 04/14/2024] Open
Abstract
Tumid lupus erythematosus (TLE) has been the subject of heated debate regarding its correct nosographic classification. The definition of TLE has changed over time, varying according to the different studies performed. In this review, we address the initial definition of TLE, the changes that have taken place in the understanding of TLE, and its placement within the classification of cutaneous lupus erythematosus (CLE), with a focus on clinical, histopathological, immunophenotypical, and differential diagnosis aspects.
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Affiliation(s)
- Maged Daruish
- Dorset County Hospital NHS Foundation Trust, Dorchester DT1 2JY, UK;
| | - Francesca Ambrogio
- Section of Dermatology and Venereology, Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), University of Bari “Aldo Moro”, 70124 Bari, Italy; (F.A.); (C.F.)
| | - Caterina Foti
- Section of Dermatology and Venereology, Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), University of Bari “Aldo Moro”, 70124 Bari, Italy; (F.A.); (C.F.)
| | - Alessandra Filosa
- Pathology Department, “A. Murri” Hospital-ASUR Marche, Aree Vaste n. 4 and 5, 63900 Fermo, Italy;
| | - Gerardo Cazzato
- Section of Molecular Pathology, Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), University of Bari “Aldo Moro”, 70124 Bari, Italy
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2
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Hansen E, Pettit C, Chung CG, Korman AM. Papulonodular mucinosis with features of discoid lupus erythematosus. JAAD Case Rep 2024; 45:59-61. [PMID: 38389858 PMCID: PMC10882011 DOI: 10.1016/j.jdcr.2023.12.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2024] Open
Affiliation(s)
- Emma Hansen
- The Ohio State University College of Medicine, Columbus, Ohio
| | - Cory Pettit
- Department of Dermatology, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Catherine G Chung
- Department of Dermatology, The Ohio State University Wexner Medical Center, Columbus, Ohio
- Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Abraham M Korman
- Department of Dermatology, The Ohio State University Wexner Medical Center, Columbus, Ohio
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3
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Sanchez-Melendez S, Malik R, Kanwar R, Yang K, Nambudiri VE. Clinical epidemiology of tumid lupus erythematosus: A retrospective review of 179 patients. J Am Acad Dermatol 2024; 90:202-204. [PMID: 37769903 DOI: 10.1016/j.jaad.2023.09.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 08/30/2023] [Accepted: 09/03/2023] [Indexed: 10/03/2023]
Affiliation(s)
- Stephanie Sanchez-Melendez
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Ponce Health Sciences University, School of Medicine, Ponce, Puerto Rico
| | - Rhea Malik
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Ruhi Kanwar
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Kevin Yang
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Tufts University School of Medicine, Boston, Massachusetts
| | - Vinod E Nambudiri
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
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4
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Hajji M, Gorsane I, Badrouchi S, Litaiem N, Rammeh S, Ben Hamida F, Abderrahim E. Systemic lupus erythematosus presenting as lupus erythematosus tumidus and lupus nephritis: a case report. J Med Case Rep 2023; 17:242. [PMID: 37312164 DOI: 10.1186/s13256-023-03981-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 05/11/2023] [Indexed: 06/15/2023] Open
Abstract
BACKGROUND Lupus nephritis and lupus erythematosus tumidus (LET) are uncommon manifestations of systemic lupus erythematosus (SLE), and their coexistence as the initial presentation of SLE is exceedingly rare. Here, we report such a case, emphasizing the diagnostic challenges and therapeutic implications of this unusual association. CASE REPORT A 38-year-old North African woman presented in Nephrology department with a history of lower extremity edema, fatigue, and weight loss of 3 kg in 4 weeks. Physical examination revealed LET lesions on the chest and the Neck. Laboratory investigations showed lymphopenia, low C3 and C4 complement levels, positive antinuclear antibodies, anti-dsDNA antibodies, and anti-SSA/Ro antibodies. Renal function tests showed normal serum creatinine and nephrotic proteinuria. Renal biopsy revealed Class V lupus nephritis. Skin biopsy confirmed the diagnosis of LET, with the presence of lymphohistiocytic infiltrates and dermal mucin. The patient was diagnosed with SLE based on the 2019 EULAR/ACR criteria and treated with prednisone (1 mg/kg/day) and hydroxychloroquine. She showed significant improvement in her cutaneous and renal symptoms at 6 and 12 months follow-up. CONCLUSION The rarity of the coexistence of LET and lupus nephritis as the initial manifestation of SLE, especially in the North African population, underscores the need for further research to elucidate the immunopathogenic mechanisms and prognostic factors associated with this association.
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Affiliation(s)
- Meriam Hajji
- Department of Medicine A, Charles Nicolle Hospital, Tunis, Tunisia.
- Kidney Pathology Laboratory LR00SP01, Charles Nicolle Hospital, Tunis, Tunisia.
- Faculty of Medicine of Tunis, El Manar University, Tunis, Tunisia.
| | - Imen Gorsane
- Department of Medicine A, Charles Nicolle Hospital, Tunis, Tunisia
- Kidney Pathology Laboratory LR00SP01, Charles Nicolle Hospital, Tunis, Tunisia
- Faculty of Medicine of Tunis, El Manar University, Tunis, Tunisia
| | - Samaraa Badrouchi
- Department of Medicine A, Charles Nicolle Hospital, Tunis, Tunisia
- Kidney Pathology Laboratory LR00SP01, Charles Nicolle Hospital, Tunis, Tunisia
- Faculty of Medicine of Tunis, El Manar University, Tunis, Tunisia
| | - Noureddine Litaiem
- Department of Dermatology, Charles Nicolle Hospital, Tunis, Tunisia
- Faculty of Medicine of Tunis, El Manar University, Tunis, Tunisia
| | - Soumaya Rammeh
- Department of Pathology, Charles Nicolle Hospital, Tunis, Tunisia
- Faculty of Medicine of Tunis, El Manar University, Tunis, Tunisia
| | - Fethi Ben Hamida
- Kidney Pathology Laboratory LR00SP01, Charles Nicolle Hospital, Tunis, Tunisia
| | - Ezzeddine Abderrahim
- Department of Medicine A, Charles Nicolle Hospital, Tunis, Tunisia
- Faculty of Medicine of Tunis, El Manar University, Tunis, Tunisia
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5
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Histology of Skin Alterations in Lupus Erythematosus. ACTA MEDICA BULGARICA 2022. [DOI: 10.2478/amb-2022-0016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
Lupus erythematosus is an autoimmune connective tissue disorder showing a broad spectrum of clinical manifestations.
The aim of this study was to assess the correlation of skin histology and different types of lupus erythematosus.
Materials and methods: Fifty-one skin specimens were assessed from 39 female and 12 male patients with acute, subcutaneous and chronic lupus erythematosus, diagnosed and treated in the Department of Dermatology and Venereology, Alexandrovska University Hospital for a 4-year period.
Results: Follicular hyperkeratosis, epidermal atrophy, vacuolar degeneration and interface dermatitis were the most frequently observed lesions in chronic cutaneous lupus erythematosus while diffuse hyperkeratosis, epidermal atrophy and indistinct interface dermatitis in the dermis were predominant in subacute cutaneous lupus erythematosus. Lupus tumidus, a rare intermittent variant of cutaneous lupus erythematosus, showed almost no epidermal involvement and mucin deposition in the dermis. However, in one of our lupus tumidus patients the disease progressed to a systemic form with histological changes of acute cutaneous lupus erythematosus including atrophy, dermal-epidermal smoothing and lymphocytic infiltration in the dermis. Of note, a few patients showed histological changes of urticarial vasculitis-like and rheumatic-like patterns.
Conclusion: The correlation of clinical course, histopathological findings and immunological tests are of vital importance for the correct diagnosis and follow up of patients with lupus erythematodes, thus preventing complications and improving their quality of life.
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6
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Bitar C, Menge TD, Chan MP. Cutaneous manifestations of lupus erythematosus: A practical clinicopathologic review for pathologists. Histopathology 2021; 80:233-250. [PMID: 34197657 DOI: 10.1111/his.14440] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Accepted: 06/30/2021] [Indexed: 11/27/2022]
Abstract
Accurate diagnosis of connective tissue diseases is often challenging and relies on careful correlation between clinical and histopathologic features, direct immunofluorescence studies, and laboratory workup. Lupus erythematosus (LE) is a prototype of connective tissue disease with a variety of cutaneous and systemic manifestations. Microscopically, cutaneous LE is classically characterized by an interface dermatitis, although other histopathologic patterns also exist depending on the clinical presentation, location, and chronicity of the skin lesions. In this article, we review the clinical, serologic, histopathologic, and direct immunofluorescence findings in LE-specific and LE-nonspecific skin lesions, with an emphasis on lesser known variants, newly described features, and helpful ancillary studies. This review will guide general pathologists and dermatopathologists in accurately diagnosing and subclassifying cutaneous LE.
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Affiliation(s)
- Carole Bitar
- Department of Pathology, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA.,Department of Dermatology, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Tyler D Menge
- Department of Pathology, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA.,Department of Dermatology, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
| | - May P Chan
- Department of Pathology, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA.,Department of Dermatology, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
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7
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Nieto Jiménez AI. Infiltración Linfocitaria de Jessner-Kanof. Reporte de un caso. BIONATURA 2020. [DOI: 10.21931/rb/2020.05.03.15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Se presenta una paciente de raza blanca, de 48 años de edad, valorada en el servicio de Dermatología, refiriendo una mancha roja y escamosa en forma de línea en la frente de 1 año de evolución, que en ocasiones se acompañaba de ardor. Había utilizado varios tratamientos médicos sin mejoría, por lo que acude a nuestro servicio. Fue valorada y examinada detenidamente y se plantearon como diagnósticos probables: una Esclerodermia lineal, un Lupus Eritematoso Fijo Discoide Crónico y una Infiltración Linfocitaria de Jessner. Se realizó biopsia cutánea que confirmó que se trataba de una Infiltración Linfocitaria de Jessner-Kanof. Esta entidad es muy rara y controvertida. Se instauró tratamiento con antipalúdicos con mejoría total del cuadro cutáneo.
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8
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Almousa S, Ahmad T, Hamdan S, Katt N. Lupus erythematosus tumidus (LET) with autoimmune thyroid dysfunction (AITD) as the first presentation of systemic lupus erythematosus: A case report and review of the literature. THE EGYPTIAN RHEUMATOLOGIST 2020. [DOI: 10.1016/j.ejr.2020.02.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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9
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Barrios M, Nathan N, Trowbridge R, Plovanich M, Nazarian RM, Kroshinsky D. A 23-Year-Old Man with Hyper-IgM Syndrome Presenting with Asymptomatic Violaceous Facial Plaques. Dermatopathology (Basel) 2020; 6:246-250. [PMID: 32083062 PMCID: PMC7011746 DOI: 10.1159/000503744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Accepted: 09/29/2019] [Indexed: 11/20/2022] Open
Abstract
Tumid lupus is a rare subtype of chronic cutaneous lupus that is characterized by urticaria-like photosensitive plaques. Unlike discoid lupus, it has minimal to no surface change and resolves without scarring. On pathological examination, it may be distinguished from other types of lupus by abundant interstitial mucin deposits. Herein, we describe a case of tumid lupus in a 23-year-old Kuwaiti male with hyper-IgM syndrome. To our best knowledge, this is the first report of tumid lupus in a patient with a primary immunodeficiency.
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Affiliation(s)
- Mirelys Barrios
- Department of Radiology, Brigham and Womens Hospital, Boston, Massachusetts, USA
| | - Neera Nathan
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts, USA.,Harvard Combined Dermatology Residency Program, Boston, Massachusetts, USA
| | - Ryan Trowbridge
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts, USA.,Harvard Combined Dermatology Residency Program, Boston, Massachusetts, USA
| | - Molly Plovanich
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts, USA.,Harvard Combined Dermatology Residency Program, Boston, Massachusetts, USA
| | - Rosalynn M Nazarian
- Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Daniela Kroshinsky
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts, USA
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10
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Patsinakidis N, Kautz O, Gibbs BF, Raap U. Lupus erythematosus tumidus: clinical perspectives. Clin Cosmet Investig Dermatol 2019; 12:707-719. [PMID: 31632119 PMCID: PMC6778445 DOI: 10.2147/ccid.s166723] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2019] [Accepted: 07/05/2019] [Indexed: 12/13/2022]
Abstract
Lupus erythematosus tumidus (LET) is an uncommon and photosensitive inflammatory skin disorder which is characterised by erythematous urticarial plaques. In the last 20 years, extensive research on clinical and histological aspects of the disease have led to a better characterization of this nosological entity and to differentiate it from other similar or related diseases. Today, LET is considered as a separate subtype of cutaneous lupus erythematosus (CLE) with a benign, intermittent clinical course (intermittent CLE, ICLE) and only rarely associated with systemic lupus erythematosus (SLE).
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Affiliation(s)
- Nikolaos Patsinakidis
- University Clinic of Dermatology and Allergology, University of Oldenburg, Klinikum Oldenburg Aör, Oldenburg, Germany.,Division of Experimental Allergy and Immunodermatology, University of Oldenburg, Oldenburg, Germany
| | - Ocko Kautz
- University Clinic of Dermatology and Allergology, University of Oldenburg, Klinikum Oldenburg Aör, Oldenburg, Germany
| | - Bernhard F Gibbs
- Division of Experimental Allergy and Immunodermatology, University of Oldenburg, Oldenburg, Germany
| | - Ulrike Raap
- University Clinic of Dermatology and Allergology, University of Oldenburg, Klinikum Oldenburg Aör, Oldenburg, Germany.,Division of Experimental Allergy and Immunodermatology, University of Oldenburg, Oldenburg, Germany
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11
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Li Q, Wu H, Liao W, Zhao M, Chan V, Li L, Zheng M, Chen G, Zhang J, Lau CS, Lu Q. A comprehensive review of immune-mediated dermatopathology in systemic lupus erythematosus. J Autoimmun 2018; 93:1-15. [DOI: 10.1016/j.jaut.2018.07.007] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Accepted: 07/05/2018] [Indexed: 12/15/2022]
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12
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Abstract
RATIONALE Lupus erythematosus tumidus (LET) is an uncommon type of cutaneous lupus erythematosus (CLE) that is rarely associated with other forms of lupus erythematosus. PATIENT CONCERNS We report a 62-year-old Chinese man presented with recurrent erythematous facial plaques for 1 year and a low-grade fever for 1 week. He had been diagnosed as discoid lupus erythematosus (DLE) 1 year before. Physical examination showed diverse lesions, including prominent swelling of the eyelids, a few erythematous, edematous plaques on the left forehead, face, and neck, and 2 hairless macules. The histopathologic findings reveal liquefaction degeneration of the basal cells, perivascular, and periadnexal infiltration of lymphocytes, and interstitial mucin deposition in the superficial, and deep dermis. DIAGNOSES A diagnosis of LET was made on clinical and histological features. INTERVENTIONS The patient started treatment with prednisolone (1 mg/kg. d), combined with hydroxychloroquine (200 mg twice daily), and topical tacrolimus. OUTCOMES The cutaneous lesions completely cleared after a period of 3 months. No adverse effects or clinical evidence of recurrence had been found during the 6-month follow-up period. LESSONS We report a case of LET converted from DLE with diverse lesions, unusual pathologic findings and slow response to the treatment of corticosteroids combined with hydroxychloroquine. We speculate that a continuous spectrum may include DLE, LET, and systemic lupus erythematosus (SLE), these 3 entities could potentially, convert between each other.
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13
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Bousquet Muylaert BP, Braga BB, Esteves EB, Garbelini LEB, Michalany AO, Oliveira JD. Lupus tumidus: a report of two cases. An Bras Dermatol 2017; 91:87-89. [PMID: 28300905 PMCID: PMC5325004 DOI: 10.1590/abd1806-4841.20164940] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Accepted: 10/21/2015] [Indexed: 11/21/2022] Open
Abstract
Lupus tumidus is considered a rare subtype of chronic cutaneous lupus erythematosus, characterized by erythema and bright urticarial erythematous-violaceous lesions that leave no scars after regression. Histopathology reveals perivascular and periannexal lymphohistiocytic infiltrates in the papillary and reticular dermis and interstitial mucin deposition. Treatment is based on photoprotection, topical corticosteroids and antimalarials. We report two cases of lupus tumidus, which deserve attention for their low frequency in the literature, in addition to their relevance as a differential diagnosis among dermatologic disorders.
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14
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Patsinakidis N, Gambichler T, Lahner N, Moellenhoff K, Kreuter A. Cutaneous characteristics and association with antinuclear antibodies in 402 patients with different subtypes of lupus erythematosus. J Eur Acad Dermatol Venereol 2016; 30:2097-2104. [PMID: 27431977 DOI: 10.1111/jdv.13769] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Accepted: 04/01/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND Lupus erythematosus (LE) is an autoimmune disease characterized by a heterogeneous spectrum of skin manifestations and organ affection, and is frequently associated with serum autoantibodies, which mostly remain positive through the course of the disease. The classification of LE is still a controversial topic. OBJECTIVES To examine the prevalence and long-term course of autoantibodies in patients with cutaneous LE (CLE) and/or systemic LE (SLE) treated in the outpatient clinic for connective tissue diseases of the department of Dermatology in Bochum, Germany. METHODS Four hundred and two patients with LE were evaluated for antinuclear antibodies at a whole of 1572 time points. The prevalence as well as the long-term positivity of antinuclear antibodies and their correlation with the various subtypes of disease was examined. RESULTS Antinuclear antibody (ANA) testing and anti-ds-DNA antibodies were not only more prevalent in SLE patients (as expected from the ACR criteria for diagnosis of SLE, P < 0.0001), but also have had a more consistent course in the long-term evaluation (P = 0.0001 and P = 0.0111 respectively). Subacute cutaneous LE (SCLE) was associated with ANA (P = 0.0075), anti-Ro (P < 0.0001) and anti-La (P < 0.0001) antibodies, showing also higher consistency rates for these antibodies than discoid LE (DLE, P = 0.049, P = 0.004, P = 0.0004). Our data from 100 patients with LE tumidus (LET) support its perception as a distinct subtype of LE, not correlating with systemic disease or antinuclear antibodies (P < 0.0001). Anti-U1-ribonucleoprotein antibodies correlated with CLE in SLE patients (P = 0.0237), whereas non-LE-specific antinuclear antibodies were a rare, inconsistent autoimmune epiphenomenon in patients with SLE. CONCLUSION Long-term analysis of antinuclear antibodies has shown significant differences in various clinical subtypes of LE, confirming the actual classification of the disease. A serial evaluation of antinuclear antibodies may support the classification of disease in LE patients with overlapping clinical features.
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Affiliation(s)
- N Patsinakidis
- Connective tissue disease research unit of the Department of Dermatology, Venereology, and Allergology, Ruhr-University Bochum, Bochum, Germany
| | - T Gambichler
- Connective tissue disease research unit of the Department of Dermatology, Venereology, and Allergology, Ruhr-University Bochum, Bochum, Germany
| | - N Lahner
- Connective tissue disease research unit of the Department of Dermatology, Venereology, and Allergology, Ruhr-University Bochum, Bochum, Germany
| | - K Moellenhoff
- Connective tissue disease research unit of the Department of Dermatology, Venereology, and Allergology, Ruhr-University Bochum, Bochum, Germany
| | - A Kreuter
- Connective tissue disease research unit of the Department of Dermatology, Venereology, and Allergology, Ruhr-University Bochum, Bochum, Germany
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15
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Jolly M, Laumann AE, Shea CR, Utset TO. Lupus erythematosus tumidus in systemic lupus erythematosus: novel association and possible role of early treatment in prevention of discoid lupus erythematosus. Lupus 2016; 13:64-9. [PMID: 14870920 DOI: 10.1191/0961203304lu473cr] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Skin involvement in systemic lupus erythematosus (SLE) occurs in varied forms. Lupus erythematosus tumidus (LET) is not known to occur with SLE. In our patient presented below, LET occurred in a patient with SLE. Some of the lesions progressedto scarring discoid lesions, while others responded very well to hydoxychloroquine treatment. We, as rheumatologists, are not very aware of this entity, which is so amenable to prevention and treatment if recognized correctly.
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Affiliation(s)
- M Jolly
- Department of Medicine, Christ Medical Center, Oak Lawn, Illinois 60453, USA.
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16
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Abstract
There have been few reports of lupus erythematosus tumidus (LET) in the literature. Most of textbooks of dermatology or dermatopathology mention this entity only briefly, if at all. The authors describe an additional case of this underdiagnosed disorder that further supports its existence as a separate entity in the spectrum of the variants of chronic cutaneous lupus erythematosus. Although most cases are reported in the European countries, to our knowledge, this is the first case documented in Portugal. The clinical, photobiological and histological features as well as differential diagnosis, treatment and prognosis are also discussed.
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Affiliation(s)
- M Teixeira
- Department of Dermatology, Hospital Geral de Santo António, Porto, Portugal.
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17
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Guarneri C, Lentini M, Polimeni G, Giuffrida R, Cannavò SP. Ustekinumab-induced drug eruption resembling lymphocytic infiltration (of Jessner-Kanof) and lupus erythematosus tumidus. Br J Clin Pharmacol 2015; 81:792-4. [PMID: 26616890 DOI: 10.1111/bcp.12837] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Revised: 10/29/2015] [Accepted: 11/15/2015] [Indexed: 01/22/2023] Open
Affiliation(s)
- Claudio Guarneri
- Department of Clinical Experimental Medicine, Section of Dermatology, A.O.U. Policlinico 'G. Martino', University of Messina, Messina, Italy
| | - Maria Lentini
- Department of Human Pathology, A.O.U. Policlinico 'G. Martino', University of Messina, Messina, Italy
| | - Giovanni Polimeni
- Unit of Clinical Pharmacology, Sicilian Regional Centre of Pharmacovigilance, A.O.U. Policlinico 'G. Martino', University of Messina, Messina, Italy
| | - Roberta Giuffrida
- Department of Clinical Experimental Medicine, Section of Dermatology, A.O.U. Policlinico 'G. Martino', University of Messina, Messina, Italy
| | - Serafinella P Cannavò
- Department of Clinical Experimental Medicine, Section of Dermatology, A.O.U. Policlinico 'G. Martino', University of Messina, Messina, Italy
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18
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Trofimov PN, Antonova OV, Shvyrev DN, Khairutdinov VR, Belousova IE, Samtsov AV. Cutaneous lupus erythematosus: pathogenesis, clinical pattern, diagnostics, therapy. VESTNIK DERMATOLOGII I VENEROLOGII 2015. [DOI: 10.25208/0042-4609-2015-91-5-24-33] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
This article contains the latest information about the mechanisms of development of lupus erythematosus based on the literature review. The modern classification of specific and non-specific skin lesions in lupus erythematosus is shown.The authors described the clinical pattern of cutaneous forms of lupus erythematosus very detailed. the data about pathological and immunological criteria for the disease diagnostics, modern methods of pharmacotherapy lupus erythematosus was classified.
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19
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Kotrekhova LP, Vashkevich AA. An experience of using methylprednisolone aceponate in the therapy of lupus erythematosus tumidus. VESTNIK DERMATOLOGII I VENEROLOGII 2015. [DOI: 10.25208/0042-4609-2015-91-4-132-136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
Lupus erythematosus tumidus is a rare skin form of lupus erythematosus. About 250 cases of lupus erythematosus tumidus have been described in the world by now. A specific clinical sign of this dermatosis is the appearance of annular or arcuate urticaria-like rash. As a rule, the appearance of the rash is preceded by ultraviolet irradiation. The administration of glucocorticosteroid drugs of local action belonging to classes of potent and very potent steroids is the first-line therapy for lupus erythematosus tumidus. The authors describe a case of the successful treatment of lupus erythematosus tumidus with methylprednisolone aceponate (Advantan ointment) in a female patient aged 56.
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Vincent JG, Chan MP. Specificity of dermal mucin in the diagnosis of lupus erythematosus: comparison with other dermatitides and normal skin. J Cutan Pathol 2015; 42:722-9. [DOI: 10.1111/cup.12504] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Revised: 03/14/2015] [Accepted: 03/15/2015] [Indexed: 11/29/2022]
Affiliation(s)
| | - May P. Chan
- Department of Pathology; University of Michigan; Ann Arbor MI USA
- Department of Dermatology; University of Michigan; Ann Arbor MI USA
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21
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Rodriguez-Caruncho C, Bielsa I, Fernández-Figueras MT, Roca J, Carrascosa JM, Ferrándiz C. Lupus erythematosus tumidus: a clinical and histological study of 25 cases. Lupus 2014; 24:751-5. [DOI: 10.1177/0961203314560204] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2014] [Accepted: 10/28/2014] [Indexed: 11/15/2022]
Abstract
Background Lupus erythematosus tumidus (LET) is a subtype of cutaneous lupus erythematosus (CLE) that has been well characterized in recent years. However, some controversy still remains concerning the histological features of epidermal involvement. Objectives The objective of this report is to describe the clinical and microscopic features of LET in patients diagnosed at Hospital Universitari Germans Trias i Pujol, Spain. Methods We conducted a retrospective study of 25 patients with a diagnosis of LET. Results All patients presented with typical LET lesions (smooth, erythematous plaques without macroscopic epidermal changes, such as follicular plugs or scale, that resolved without residual scarring or hypopigmentation). None of the patients fulfilled the criteria for systemic lupus erythematosus during follow-up. Test results for antinuclear antibodies were positive in five patients (20%), with titres below one of 320 in all cases. Twenty-two patients (88%) required antimalarial therapy; response was good in 70% and moderate response in 30%. Minor epidermal alterations were observed in 52% of biopsy specimens, with focal basal vacuolization being the most frequent. Conclusions LET is a variant of CLE that has distinctive clinical, histologic and prognostic features. Unlike the patients in the case series previously described in the literature, most of our patients required treatment with antimalarials. Histology revealed mild epidermal alterations in a significant percentage of patients. Thus, in our opinion, the absence of microscopic epidermal alterations is not constant in LET.
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Affiliation(s)
- C Rodriguez-Caruncho
- Department of Dermatology, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - I Bielsa
- Department of Dermatology, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - M T Fernández-Figueras
- Department of Pathology, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - J Roca
- Department of Epidemiology, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - J M Carrascosa
- Department of Dermatology, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - C Ferrándiz
- Department of Dermatology, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
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22
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Cinotti E, Merlo V, Kempf W, Carli C, Kanitakis J, Parodi A, Rongioletti F. Reticular erythematous mucinosis: histopathological and immunohistochemical features of 25 patients compared with 25 cases of lupus erythematosus tumidus. J Eur Acad Dermatol Venereol 2014; 29:689-97. [PMID: 25087914 DOI: 10.1111/jdv.12654] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2014] [Accepted: 06/25/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND OBJECTIVES Reticular erythematous mucinosis (REM) and lupus erythematosus tumidus (LET) share similarities. However, to our knowledge no study extensively compared the histological features of these two conditions. The aim of this study is to compare the histological and immunohistochemical features of REM and LET. METHODS We evaluated epidermal thickness, hyperkeratosis, dermo-epidermal junction changes, interstitial mucin deposition, vessel dilatation and pattern, type and density of the inflammatory infiltrate in 25 cases of REM and LET. Anti-CD3, anti-CD20, anti-CD68, anti-CD4, anti-CD8, anti-CD123, anti-CD2AP, anti-IgG and anti-C3 antibodies were tested in a subset of patients. RESULTS Both diseases are characterized by perivascular dermal infiltrates of lymphocytes mainly CD4+ positive and increased dermal mucin. However, REM tended to show more scattered and more superficial lymphocytes with more superficial mucin and to have less frequent immunoglobulin and complement depositions along the dermo-epidermal junction. Plasmacytoid dendritic cells (PDCs) were less represented in REM, and were mainly found as single cells differently from LET. CONCLUSIONS REM and LET present some differences in the infiltrate, including PDCs, the mucin deposition and the immunoreactant deposition at the dermo-epidermal junction that justify the distinction of the two diseases and suggest different pathogenetic mechanisms.
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Affiliation(s)
- E Cinotti
- Section of Dermatology, Department of Health Sciences (DISSAL), University of Genoa and IRCCS San Martino-IST University Hospital, Genoa, Italy; Section of Dermatology, University Hospital of Saint-Etienne, Saint-Etienne, France
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23
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Brown TT, Choi EYK, Thomas DG, Hristov AC, Chan MP. Comparative analysis of rosacea and cutaneous lupus erythematosus: Histopathologic features, T-cell subsets, and plasmacytoid dendritic cells. J Am Acad Dermatol 2014; 71:100-7. [DOI: 10.1016/j.jaad.2014.01.892] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2013] [Revised: 01/17/2014] [Accepted: 01/21/2014] [Indexed: 01/14/2023]
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24
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Kuhn A, Landmann A. The classification and diagnosis of cutaneous lupus erythematosus. J Autoimmun 2014; 48-49:14-9. [PMID: 24486120 DOI: 10.1016/j.jaut.2014.01.021] [Citation(s) in RCA: 139] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2013] [Accepted: 11/13/2013] [Indexed: 02/08/2023]
Abstract
Lupus erythematosus (LE) is an inflammatory connective tissue disease of generalized autoimmunity characterized by pathogenic autoantibodies and immune complexes, attributed to loss of immune tolerance. Cutaneous involvement, which appears in the majority of patients with the disease, can present as LE-specific or LE-nonspecific manifestations. The LE-nonspecific manifestations include e.g. vascular skin changes and may be associated with systemic organ manifestations or other autoimmune diseases. In contrast, the LE-specific manifestations encompass the various subtypes of cutaneous lupus erythematosus (CLE), which are classified as separate entities without or with less severe systemic organ involvement. In the "Duesseldorf Classification", CLE is subdivided into four different categories: acute CLE (ACLE), subacute CLE (SCLE), chronic CLE (CCLE), and intermittent CLE (ICLE). Differentiation between these subtypes is based on clinical features and average duration of the cutaneous lesions, but can also consider histological changes of skin biopsy specimens and laboratory abnormalities. In addition, direct immunofluorescence and photoprovocation may be applied to confirm the diagnosis in specific cases. Further investigations should be considered dependent on the clinical symptoms of the CLE patient and the results of the laboratory tests. A revised scoring system, the Cutaneous Lupus Erythematosus Disease Area and Severity Index (RCLASI) has recently been validated to assess disease activity and damage in CLE. In this review, we focus on the classification of CLE and the diagnostic procedures to identify and confirm the different subtypes of the disease.
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Affiliation(s)
- Annegret Kuhn
- Department of Dermatology, University of Muenster, Germany; Division of Immunogenetics, Tumor Immunology Program, German Cancer Research Center, Heidelberg, Germany.
| | - Aysche Landmann
- Division of Immunogenetics, Tumor Immunology Program, German Cancer Research Center, Heidelberg, Germany
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25
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Sidhu HK, Dukes GD, Goldenberg G. Dermatopathology of rheumatologic diseases. ACTA ACUST UNITED AC 2014. [DOI: 10.1586/edm.12.10] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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26
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Rodríguez-Caruncho C, Bielsa I. Lupus Erythematosus Tumidus: A Clinical Entity Still Being Defined. ACTAS DERMO-SIFILIOGRAFICAS 2011. [DOI: 10.1016/j.adengl.2011.11.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
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27
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Rodríguez-Caruncho C, Bielsa I. Lupus eritematoso túmido, una entidad en proceso de definición. ACTAS DERMO-SIFILIOGRAFICAS 2011; 102:668-74. [DOI: 10.1016/j.ad.2011.04.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2011] [Revised: 04/11/2011] [Accepted: 04/15/2011] [Indexed: 10/17/2022] Open
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28
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Kuhn A, Ruland V, Bonsmann G. [Skin manifestations in lupus erythematosus: clinical aspects and therapy]. Z Rheumatol 2011; 70:213-26; quiz 227. [PMID: 21494937 DOI: 10.1007/s00393-011-0789-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Lupus erythematosus (LE) is an inflammatory autoimmune disorder, which is characterized by clinically heterogeneous manifestations of different organs. In systemic LE (SLE) the skin, the musculoskeletal system, the kidneys, the cardiovascular and central nervous systems can be involved. The skin lesions can be divided into LE-specific and LE-non-specific manifestations, the former represent the subtypes of cutaneous LE (CLE). The diagnosis is confirmed by clinical, histopathological, immunoserological and genetic features. The treatment is similar for the different subtypes of CLE; however, the therapeutic regimen should be individually defined in each patient. Antimalarials are still the first-line systemic therapy and in addition to sunscreens, glucocorticosteroids and calcineurin inhibitors have an important impact as topical agents in this disease.
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Affiliation(s)
- A Kuhn
- Klinik und Poliklinik für Hautkrankheiten, Universitätsklinikum Münster, Münster, Deutschland.
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29
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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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30
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Wenzel J, Zahn S, Tüting T. Pathogenesis of cutaneous lupus erythematosus: common and different features in distinct subsets. Lupus 2010; 19:1020-8. [PMID: 20693195 DOI: 10.1177/0961203310370046] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
The term 'cutaneous lupus erythematosus' (CLE) comprises several related autoimmune skin disorders, defined as 'specific' skin manifestations of lupus erythematosus (LE). The spectrum of clinical presentation of CLE is wide, reaching from mild erythema to disseminated scarring skin lesions. There is increasing knowledge concerning the pathogenesis of LE skin lesions and it has been shown that a complex network of cutaneous cytokines, chemokines and adhesion molecules orchestrate and promote tissue injury observed in LE skin lesions. However, a complete understanding of the diverse pathophysiological mechanisms in the different CLE subsets does not exist. Here we review the main pathological features described in CLE patients against the background of the clinical diversity of different CLE subtypes.
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Affiliation(s)
- J Wenzel
- Department of Dermatology, University of Bonn, Germany.
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31
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Sepehr A, Wenson S, Tahan SR. Histopathologic manifestations of systemic diseases: the example of cutaneous lupus erythematosus. J Cutan Pathol 2010; 37 Suppl 1:112-24. [PMID: 20482683 DOI: 10.1111/j.1600-0560.2010.01510.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Alireza Sepehr
- Department of Pathology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA.
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32
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Kuhn A, Ruland V, Bonsmann G. Photosensitivity, phototesting, and photoprotection in cutaneous lupus erythematosus. Lupus 2010; 19:1036-46. [DOI: 10.1177/0961203310370344] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Cutaneous lupus erythematosus (CLE) is a heterogeneous autoimmune disease involving well-defined skin lesions that can be categorized as acute CLE (ACLE), subacute CLE (SCLE), chronic CLE (CCLE), or intermittent CLE (ICLE). It is commonly accepted that ultraviolet (UV) exposure can induce and exacerbate skin lesions in patients with certain subtypes of CLE. Phototesting with UVA and UVB irradiation using a standardized protocol has proven to be a reliable model to study photosensitivity in CLE and to analyse the underlying pathomechanisms of the disease. In addition to UV-mediated induction of apoptosis, the molecular and cellular factors that may underlie the abnormal long-lasting photoreactivity in CLE include mediators of inflammation such as cytokines and chemokines, inducible nitric oxide (NO) synthase (iNOS), and cellular adhesion molecules. The photosensitivity associated with CLE requires education of the patient about avoidance of excessive sun exposure, continuous photoprotection through physical measures such as protective clothing, and daily application of broad-spectrum sunscreens. Novel approaches to UV-protection, such as alpha-MSH or thymidine dinucleotides, might also have an impact on photosensitivity in patients with CLE. In this review, we summarize the current knowledge about photosensitivity in patients with CLE, including an overview of standardized phototesting procedures, possible molecular pathomechanisms, and photoprotection. Lupus (2010) 19, 1036—1046.
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Affiliation(s)
- A. Kuhn
- Department of Dermatology, University of Münster, Münster, Germany,
| | - V. Ruland
- Department of Dermatology, University of Münster, Münster, Germany
| | - G. Bonsmann
- Department of Dermatology, University of Münster, Münster, Germany
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33
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Kuhn A, Ruland V, Bonsmann G. Lupus erythematosus tumidus as a separate subtype of cutaneous lupus erythematosus: reply from authors. Br J Dermatol 2010. [DOI: 10.1111/j.1365-2133.2010.09796.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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34
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Klein RS, Morganroth PA, Werth VP. Cutaneous lupus and the Cutaneous Lupus Erythematosus Disease Area and Severity Index instrument. Rheum Dis Clin North Am 2010; 36:33-51, vii. [PMID: 20202590 DOI: 10.1016/j.rdc.2009.12.001] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This article provides an overview of cutaneous lupus erythematosus, including classification schemes, disease subtypes, and therapy. It also describes the Cutaneous Lupus Erythematosus Disease Area and Severity Index, a novel clinical outcome instrument that quantifies cutaneous activity and damage in cutaneous lupus erythematosus.
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35
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Deligny C, Clyti E, Sainte-Marie D, Couppie P, Huong DLT, Piette JC, Arfi S, Pradinaud R. Incidence of chronic cutaneous lupus erythematosus in French Guiana: A retrospective population-based study. Arthritis Care Res (Hoboken) 2010; 62:279-82. [DOI: 10.1002/acr.20079] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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36
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Schmitt V, Meuth A, Amler S, Kuehn E, Haust M, Messer G, Bekou V, Sauerland C, Metze D, Köpcke W, Bonsmann G, Kuhn A. Lupus erythematosus tumidus is a separate subtype of cutaneous lupus erythematosus. Br J Dermatol 2009; 162:64-73. [DOI: 10.1111/j.1365-2133.2009.09401.x] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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37
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Nishiyama M, Kanazawa N, Hiroi A, Furukawa F. Lupus erythematosus tumidus in Japan: a case report and a review of the literature. Mod Rheumatol 2009; 19:567-72. [PMID: 19562251 DOI: 10.1007/s10165-009-0192-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2009] [Accepted: 05/25/2009] [Indexed: 11/30/2022]
Abstract
We report here the case of a 48-year-old Japanese woman showing plaque-forming scattered indurative papules on her face, buttock and extremities. Histological examination revealed a large amount of interstitial mucin deposition, and negative direct immunofluorescence was observed. The provocative phototesting reproduced the skin lesion, and the patient was diagnosed with lupus erythematosus tumidus (LET). A review of ten LET cases previously reported in Japan revealed that all of these cases had clinicopathological features similar to those reported for European cases, although not all of the former fully satisfied the European criteria.
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Affiliation(s)
- Mizuho Nishiyama
- Department of Dermatology, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-0012, Japan.
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38
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40
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41
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Coexistence of tumid lupus erythematosus with systemic lupus erythematosus and discoid lupus erythematosus: a report of two cases of tumid lupus. J Clin Rheumatol 2009; 14:338-41. [PMID: 18664992 DOI: 10.1097/rhu.0b013e31817d1183] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Tumid lupus erythematosus (LE) is a rare variant of chronic cutaneous LE that is characterized clinically by smooth, nonscarring, pink to violaceous papules or plaques without evidence of surface change. Histopathologic features include superficial and deep lymphocytic infiltration in a perivascular and periadnexal distribution, with dermal interstitial mucin deposition and focal or absent dermoepidermal junction involvement. These clinical and histopathologic features can be challenging to differentiate from other cutaneous diseases. This is particularly true because patients with tumid LE usually do not have other manifestations of systemic LE or cutaneous LE. We present 2 cases of tumid LE, one associated with concomitant systemic LE and the other occurring concurrently with discoid LE. Furthermore, we demonstrate the rare occurrence of a patient with tumid LE occurring below the waist at a photo-protected site.
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42
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Obermoser G, Schwingshackl P, Weber F, Stanarevic G, Zelger B, Romani N, Sepp N. Recruitment of plasmacytoid dendritic cells in ultraviolet irradiation-induced lupus erythematosus tumidus. Br J Dermatol 2009; 160:197-200. [DOI: 10.1111/j.1365-2133.2008.08873.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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43
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Stavropoulos PG, Goules AV, Avgerinou G, Katsambas AD. Pathogenesis of subacute cutaneous lupus erythematosus. J Eur Acad Dermatol Venereol 2008; 22:1281-9. [DOI: 10.1111/j.1468-3083.2008.02806.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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44
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Wozniacka A, Robak E, McCauliffe DP, Sysa-Jedrzejowska A. The evolution of multiple forms of cutaneous lupus erythematosus in the same patient over time. J Eur Acad Dermatol Venereol 2008; 22:1237-9. [PMID: 18826552 DOI: 10.1111/j.1468-3083.2007.02594.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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45
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Wozniacka A, Robak E, McCauliffe DP, Sysa-Jedrzejowska A. The evolution of multiple forms of cutaneous lupus erythematosus in the same patient over time. J Eur Acad Dermatol Venereol 2008. [DOI: 10.1111/j.1468-3083.2008.02594.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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46
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Rémy-Leroux V, Léonard F, Lambert D, Wechsler J, Cribier B, Thomas P, Adamski H, Marguery MC, Aubin F, Leroy D, Bernard P. Comparison of histopathologic–clinical characteristics of Jessner's lymphocytic infiltration of the skin and lupus erythematosus tumidus: Multicenter study of 46 cases. J Am Acad Dermatol 2008; 58:217-23. [DOI: 10.1016/j.jaad.2007.09.039] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2007] [Revised: 08/30/2007] [Accepted: 09/19/2007] [Indexed: 11/17/2022]
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47
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Wollina U, Hansel G. The use of topical calcineurin inhibitors in lupus erythematosus: an overview. J Eur Acad Dermatol Venereol 2007; 22:1-6. [PMID: 18005117 DOI: 10.1111/j.1468-3083.2007.02427.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Lupus erythematosus (LE) shows a broad range of cutaneous symptoms, including acute, subacute and chronic lesions. The gold standard of established topical treatment consists of medium- to high-potency corticosteroids. Because face and neck are often involved, adverse effects of prolonged corticosteroid use are not uncommon. There is a need of steroid-free topical treatment in LE. With the development of topical calcineurin inhibitors, tacrolimus and pimecrolimus, there is an alternative available. The present study reviews the literature data on topical tacrolimus and pimecrolimus for malar rash, subacute lesions and discoid chronic lesions among others. The present data argue for an efficacy of these compounds in acute and subacute cutaneous LE manifestations with a rapid response and only minor side-effects when used as an adjunct to systemic treatment. In chronic discoid LE, hypertrophic plaques do not well respond because of limited penetration. The primary target seems to be the decrease or blocking of cytokine production by activated T lymphocytes.
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Affiliation(s)
- U Wollina
- Department of Dermatology and Allergology, Academic Teaching Hospital Dresden-Friedrichstadt, Dresden, Germany.
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48
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Franz B, Fritzsching B, Riehl A, Oberle N, Klemke CD, Sykora J, Quick S, Stumpf C, Hartmann M, Enk A, Ruzicka T, Krammer PH, Suri-Payer E, Kuhn A. Low number of regulatory T cells in skin lesions of patients with cutaneous lupus erythematosus. ACTA ACUST UNITED AC 2007; 56:1910-20. [PMID: 17530636 DOI: 10.1002/art.22699] [Citation(s) in RCA: 102] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To define the phenotype and function of CD4+,CD25+ regulatory T cells (Treg) in patients with cutaneous lupus erythematosus (CLE), a heterogeneous autoimmune disease characterized primarily by inflammatory skin lesions. METHODS The number of Treg in skin specimens obtained from patients with various subtypes of CLE was investigated by immunohistochemical analysis, using anti-Foxp3 and anti-CD4 monoclonal antibodies. Furthermore, characterization of peripheral blood CD4+,CD25+ Treg from normal healthy donors and patients with CLE was carried out by flow cytometry, analyzing the expression of Foxp3 and Treg subpopulations. We also purified CD4+,CD25(high) Treg obtained from patients with CLE and tested the sensitivity of these cells to CD95L-mediated apoptosis. RESULTS Quantitative analysis of CD4+ T cells in skin lesions from patients with CLE revealed that the number was similar to that in lesions from patients with other chronic inflammatory diseases, but the number of Foxp3+ Treg in CLE was significantly reduced. There was no correlation between disease subtype and the frequency of Foxp3+ Treg in the skin of patients with CLE. In peripheral blood, no significant differences were observed in the number and phenotype of CD4+,CD25+ Treg or in the sensitivity to apoptosis of CD4+,CD25(high) Treg derived from patients with CLE and those derived from normal healthy donors. CONCLUSION These data suggest that an organ-specific abnormality of Treg in the skin underscores the importance of analyzing Treg in the affected tissue. Such a local process might give insight into the pathogenic mechanisms of CLE and differs from a global peripheral dysfunction as reported for patients with a systemic manifestation of the disease.
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Affiliation(s)
- B Franz
- German Cancer Research Center, Heidelberg, Germany
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49
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Lipsker D, Mitschler A, Grosshans E, Cribier B. Could Jessner’s Lymphocytic Infiltrate of the Skin Be a Dermal Variant of Lupus Erythematosus? An Analysis of 210 Cases. Dermatology 2006; 213:15-22. [PMID: 16778421 DOI: 10.1159/000092832] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2005] [Accepted: 01/22/2006] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND AND OBJECTIVE The objective of this study was to evaluate the relationship between Jessner's lymphocytic infiltration of the skin (JLI) and lupus erythematosus (LE), which has been the subject of debate since its initial description in 1953. MATERIAL AND METHODS This is a retrospective study including all patients with a histopathologically ascertained diagnosis of JLI performed at the Laboratoire d'Histopathologie Cutanée of the Strasbourg University Hospital between 1993 and 2003. Information about patient characteristics and follow-up data were retrieved between 2004 and 2005. Special attention was paid to features indicative of LE. RESULTS 210 consecutive patients (102 women and 108 men) with a mean age 42 years were diagnosed with JLI in the reference period. 175 patients (83%) had multiple lesions and 32 patients (15%) had only a single lesion at the time of diagnosis (data not available in 3 patients). The head, neck and upper part of the thorax were involved in 171 patients (81%). An annular or arciform configuration and/or arrangement were present in 111 patients (53%). Lesions consisted of red (100%) papules or plaques (98%). Mean follow-up was 4 years. Sixteen patients (7.6%) had proven LE. Only 2 patients (1%) developed >4 ACR criteria of systemic LE. Furthermore, 1 patient had antiphospholipid antibody syndrome and 2 patients had rheumatoid arthritis. CONCLUSIONS This high frequency of patients with typical features of LE strongly argues that JLI could be a dermal variant of LE and not an autonomous entity. It might be the cutaneous marker of a subset of LE patients with excellent prognosis.
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Affiliation(s)
- Dan Lipsker
- Clinique Dermatologique et Faculté de Médecine, Université Louis Pasteur, Strasbourg, France.
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Abstract
OBJECTIVE To study 26 cases of lupus erythematosus tumidus (LET), a subset of chronic cutaneous lupus erythematosus (CCLE), referred to in the literature as a rare entity. PATIENTS AND METHODS A retrospective study was conducted of 26 patients diagnosed with LET between 1996 and 2002. The clinical characteristics, histopathologic and laboratory findings, response to treatment, association with other subsets of lupus, course, and diagnostic criteria were analyzed. RESULTS The incidence by sex was similar. The mean age of presentation was 49.19 years. The clinical presentation usually involved erythematous, edematous plaques located on the face, chest, back, or extremities, related to sun exposure. A dermal lymphocytic infiltrate with a perivascular disposition and differing degrees of mucin deposition was observed in all cases. Minimal epidermal changes were present in 18 cases, and 11 of these also showed minimal dermal-epidermal changes. Only one case showed dermal-epidermal changes without any epidermal alteration. Direct immunofluorescence test was performed in 15 patients, and 11 were negative. All cases showed a benign course without systemic manifestations. The response to topical steroids or antimalarial treatment was excellent, but a seasonal recurrence was usually observed. Discussion No defined criteria for LET are universally accepted. The main controversies are the acceptance of LET as a separate subset of CCLE, and the histopathologic diagnostic features, mainly the presence or absence of epidermal and dermal-epidermal changes in these lesions. CONCLUSIONS No inflexible histologic criteria should be employed for the diagnosis of LET. This subset of lupus erythematosus is characterized by intense photosensitivity, definite clinical lesions, a benign course, the absence of systemic disease, good response to antimalarial treatment, and a tendency to recur. More studies should be performed in order to establish the true incidence of LET because this subset of CCLE is probably underestimated.
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Affiliation(s)
- Vanessa Vieira
- Department of Dermatology and Pathology, Hospital Juan Canalejo, La Coruña, Spain.
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