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Herzum A, Gasparini G, Cozzani E, Burlando M, Parodi A. Atypical and Rare Forms of Cutaneous Lupus Erythematosus: The Importance of the Diagnosis for the Best Management of Patients. Dermatology 2021; 238:195-204. [PMID: 34082424 DOI: 10.1159/000515766] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 03/07/2021] [Indexed: 11/19/2022] Open
Abstract
Lupus erythematosus (LE) is an autoimmune disease with a wide range of clinical and cutaneous manifestations. Along with the well-known typical cutaneous manifestations of LE, some cutaneous manifestations are rarer, but still characteristic, enabling the dermatologist and the general practitioner who know them to suspect cutaneous LE (CLE) and investigate a possible underlying systemic involvement. Indeed, not infrequently a skin manifestation is the first presentation of systemic LE (SLE), and >75% of SLE patients show signs of skin disease during the course of the illness. Especially, SLE involvement occurs in cases of acute CLE, while it is uncommon in subacute CLE and rare in chronic CLE. This review aims to concentrate especially on atypical cutaneous manifestations of LE to enable the clinician to diagnose even the rarest forms of CLE.
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Affiliation(s)
- Astrid Herzum
- Section of Dermatology, Department of Health Sciences, University of Genoa, Genoa, Italy.,Dermatology Unit, Ospedale Policlinico San Martino IRCCS, Genoa, Italy
| | - Giulia Gasparini
- Section of Dermatology, Department of Health Sciences, University of Genoa, Genoa, Italy.,Dermatology Unit, Ospedale Policlinico San Martino IRCCS, Genoa, Italy.,Department of Specialistic Medicine, University of Genoa, Genoa, Italy
| | - Emanuele Cozzani
- Section of Dermatology, Department of Health Sciences, University of Genoa, Genoa, Italy.,Dermatology Unit, Ospedale Policlinico San Martino IRCCS, Genoa, Italy
| | - Martina Burlando
- Section of Dermatology, Department of Health Sciences, University of Genoa, Genoa, Italy.,Dermatology Unit, Ospedale Policlinico San Martino IRCCS, Genoa, Italy
| | - Aurora Parodi
- Section of Dermatology, Department of Health Sciences, University of Genoa, Genoa, Italy.,Dermatology Unit, Ospedale Policlinico San Martino IRCCS, Genoa, Italy
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Wang ML, Chan MP. Comparative Analysis of Chilblain Lupus Erythematosus and Idiopathic Perniosis: Histopathologic Features and Immunohistochemistry for CD123 and CD30. Am J Dermatopathol 2018; 40:265-271. [DOI: 10.1097/dad.0000000000000945] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Prieto-Torres L, Alegría-Landa V, Morales-Moya AL, Meriño-Ibarra EE, Ara-Martín M, Requena L. Lupus panniculitis refractory to multiple therapies treated successfully with rituximab: A case report and literature review. Australas J Dermatol 2017; 59:e159-e160. [DOI: 10.1111/ajd.12685] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Lucía Prieto-Torres
- Department of Dermatology; University Hospital of Lozano Blesa; Zaragoza Spain
| | - Victoria Alegría-Landa
- Department of Dermatology; Jiménez Díaz Foundation; Autonomous University of Madrid; Madrid Spain
| | | | | | - Mariano Ara-Martín
- Department of Dermatology; University Hospital of Lozano Blesa; Zaragoza Spain
| | - Luis Requena
- Department of Dermatology; Jiménez Díaz Foundation; Autonomous University of Madrid; Madrid Spain
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Lupus mastitis as a first manifestation of systemic disease: About two cases with a review of the literature. Eur J Radiol 2017. [DOI: 10.1016/j.ejrad.2017.04.023] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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5
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Lupus erythematosus panniculitis: A case report. JOURNAL OF DERMATOLOGY & DERMATOLOGIC SURGERY 2017. [DOI: 10.1016/j.jdds.2016.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Su X, Qiao X, Li J, Gao L, Wang C, Wang L. Papulonodular mucinosis, Guillain-Barré syndrome and nephrotic syndrome in a patient with systemic lupus erythematosus: a case report. BMC Nephrol 2017; 18:43. [PMID: 28143420 PMCID: PMC5286654 DOI: 10.1186/s12882-017-0458-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Accepted: 01/23/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Awareness of the spectrum of clinical manifestations of systemic lupus erythematosus (SLE), especially uncommon changes, is essential for diagnosis and effective management of patients. CASE PRESENTATION A 26-year-old Chinese man with SLE initially manifested cutaneous papulonodular mucinosis and developed acute Guillain-Barré syndrome and class V lupus nephritis 2 years later. His cutaneous nodules had not been idententified for 2 years and were resected by surgical procedures twice until SLE was diagnosed. The kidney biopsy revealed class V lupus nephritis. The patient responded well to a short course of intravenous immunoglobulins and his muscle strength almost completely recovered. So far, he has undergone five cycles of cyclophosphamide combined with hydroxychloroquine and tapering prednisone, resulting in partial remission of lupus nephritis and disappearance of hypocomplementemia. CONCLUSION We reported a rare case of male patient with SLE with manifestation of class V lupus nephritis, Guillain-Barré syndrome and papulonodular mucinosis.
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Affiliation(s)
- Xiaole Su
- Renal Division, Shanxi Medical University Second Hospital, Shanxi Kidney Disease Institute, No.382, Wuyi Road, Xinghualing Distirct, Taiyuan, Shanxi Province, China
| | - Xi Qiao
- Renal Division, Shanxi Medical University Second Hospital, Shanxi Kidney Disease Institute, No.382, Wuyi Road, Xinghualing Distirct, Taiyuan, Shanxi Province, China
| | - Jing Li
- Renal Division, Shanxi Medical University Second Hospital, Shanxi Kidney Disease Institute, No.382, Wuyi Road, Xinghualing Distirct, Taiyuan, Shanxi Province, China
| | - Lifang Gao
- Pathology Division, Shanxi Medical University Second Hospital, Shanxi Province Kidney Pathology Centre, No.382, Wuyi Road, Xinghualing Distirct, Taiyuan, Shanxi Province, China
| | - Chen Wang
- Pathology Division, Shanxi Medical University Second Hospital, Shanxi Province Kidney Pathology Centre, No.382, Wuyi Road, Xinghualing Distirct, Taiyuan, Shanxi Province, China
| | - Lihua Wang
- Renal Division, Shanxi Medical University Second Hospital, Shanxi Kidney Disease Institute, No.382, Wuyi Road, Xinghualing Distirct, Taiyuan, Shanxi Province, China.
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Bouaziz JD, Barete S, Le Pelletier F, Amoura Z, Piette JC, Francès C. Cutaneous lesions of the digits in systemic lupus erythematosus: 50 cases. Lupus 2016; 16:163-7. [PMID: 17432100 DOI: 10.1177/0961203306075792] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The objective of this study was to observe the clinical and pathologic features of digital lesions in a cohort of 50 patients with systemic lupus erythematosus (SLE). Biopsy and pictures of digital lesions were performed in 50 consecutive patients with SLE and digital lesions. A clinical diagnosis of vasculitis was previously suggested in 36% of cases. Pictures were reviewed by three dermatologists and all the tissue sections were analysed by the same pathologist. Files of patients were reviewed retrospectively. Activity of SLE was established according to the lupus activity index (LAI). Digital lesions in SLE were frequently painful (60%) with a finger-pulp inflammation (70%). According to clinical and pathological correlation, five patients had acute cutaneous lupus, five subacute cutaneous lupus, 21 discoid lupus and 15 chilblain lupus. Two patients presented vasculitis: one had an urticarial vasculitis concomitantly to a lupus flare, the other had an erythema elevatum diutinum, independent of SLE evolution. Thrombosis of dermal vessels was present in two patients with SLE-associated antiphospholipid syndrome and in two patients with chilblain lupus. LAI was > 1.5 in only seven patients. These results highlight the tendency to clinically overestimate the prevalence of cutaneous vasculitis of the fingers in patients without active SLE. Clinical features of cutaneous lupus of the digits are polymorphous. So, a pathological examination of the lesions is often necessary for diagnosis and proper management.
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Affiliation(s)
- J D Bouaziz
- Department of Dermatology, Hôpital Tenon, Paris, France
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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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Abstract
Background: Cutaneous lupus erythematosus is known to occur at sites of trauma or inflammation of the skin, including sites of tattoo, frostbite, herpes zoster scar, burn scar, and implantation by windshield glass. Objective: We report a 32-year-old white man who developed cutaneous lupus erythematosus at the site of a laceration. The diagnosis was confirmed by histologic and immunofluorescence examination. The patient responded to intralesional corticosteroid and hydroxychloroquine therapy. Conclusion: Lupus erythematosus may be induced by trauma.
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Affiliation(s)
- Shereen Timani
- Department of Dermatology, University of Cincinnati College of Medicine, Cincinnati, OH 45267-0592, USA
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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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Nofal A, Salah E. Acquired poikiloderma: Proposed classification and diagnostic approach. J Am Acad Dermatol 2013; 69:e129-40. [DOI: 10.1016/j.jaad.2012.06.015] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2012] [Revised: 05/25/2012] [Accepted: 06/11/2012] [Indexed: 02/08/2023]
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12
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Liau JY, Chuang SS, Chu CY, Ku WH, Tsai JH, Shih TF. The presence of clusters of plasmacytoid dendritic cells is a helpful feature for differentiating lupus panniculitis from subcutaneous panniculitis-like T-cell lymphoma. Histopathology 2013; 62:1057-66. [DOI: 10.1111/his.12105] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2012] [Accepted: 01/28/2013] [Indexed: 11/29/2022]
Affiliation(s)
- Jau-Yu Liau
- Department of Pathology; College of Medicine; National Taiwan University Hospital; National Taiwan University; Taipei; Taiwan
| | - Shih-Sung Chuang
- Department of Pathology; Chi-Mei Medical Centre; Tainan and Taipei Medical University; Taipei; Taiwan
| | - Chia-Yu Chu
- Department of Dermatology; College of Medicine; National Taiwan University Hospital; National Taiwan University; Taipei; Taiwan
| | - Wen-Hui Ku
- Department of Pathology and Laboratory Medicine; Koo Foundation; Sun Yat-Sen Cancer Centre; Taipei; Taiwan
| | - Jia-Huei Tsai
- Department of Pathology; College of Medicine; National Taiwan University Hospital; National Taiwan University; Taipei; Taiwan
| | - Teng-Fu Shih
- Department of Pathology; Yuan's General Hospital; Kaohsiung; Taiwan
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Morales-Burgos A, Sánchez JL, Gonzalez-Chávez J, Vega J, Justiniano H. Periorbital mucinosis: a variant of cutaneous lupus erythematosus? J Am Acad Dermatol 2010; 62:667-71. [PMID: 20153078 DOI: 10.1016/j.jaad.2009.05.043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2008] [Revised: 05/01/2009] [Accepted: 05/15/2009] [Indexed: 10/19/2022]
Abstract
Lupus erythematosus has a wide spectrum of cutaneous manifestations, including periorbital mucinosis. We report 3 cases of periorbital mucinosis occurring in association with other cutaneous signs of lupus erythematosus. Based on a review of the literature, periorbital mucinosis is a rare and not widely recognized clinical manifestation of the disease. Although unusual, familiarity with periorbital mucinosis as a manifestation of lupus erythematosus broadens our understanding of these entities and expands the spectrum of cutaneous lupus erythematosus.
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Affiliation(s)
- Adisbeth Morales-Burgos
- Department of Dermatology, School of Medicine, University of Puerto Rico, San Juan, Puerto Rico.
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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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Cardinali C, Giomi B, Caproni M, Fabbri P. Cutaneous Hypertrophic Lupus Erythematosus in a Patient With Systemic Involvement. Skinmed 2007; 3:49-51. [PMID: 14724415 DOI: 10.1111/j.1540-9740.2004.02588.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: 10/23/2022]
Affiliation(s)
- Carla Cardinali
- Department of Dermatological Sciences, University of Florence, Florence, Italy
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Abstract
Cutaneous lupus erythematosus (CLE) includes a variety of lupus erythematosus (LE)-specific skin lesions that are subdivided into three categories - chronic CLE (CCLE), subacute CLE (SCLE) and acute CLE (ACLE) - based on clinical morphology, average duration of skin lesions and routine histopathologic examination. This paper describes our personal experience in the management of CLE over the last 30 years, with details on preferential therapeutic options related to clinical, histologic and immunopathologic aspects of each clinical subset of the disease. Effective sunscreening and sun protection are considered the first rule in the management of CLE because of the high degree of photosensitivity of the disease. Antimalarial agents are crucial in the treatment of CLE and are the first-line systemic agents, particularly in discoid LE (DLE) and SCLE. Dapsone is the drug of choice for bullous systemic LE (BSLE) as well as for LE in small dermal vessels (e.g. leukocytoclastic vasculitis). Retinoids, known as second-line drugs for systemic therapy, are sometimes used to treat chronic forms of CLE and are particularly successful in treating hypertrophic LE. Systemic immunosuppressive agents are required to manage the underlying systemic LE disease activity in patients with ACLE. These drugs, especially azathioprine, methotrexate, cyclophosphamide and cyclosporine, together with corticosteroids, constitute third-line systemic therapy of CLE. In our experience, oral prednisone or parenteral 'pulsed' methylprednisolone are useful in exacerbations of disease activity. Thalidomide provides one of the most useful therapeutic alternatives for chronic refractory DLE, although its distribution is limited to a few countries because of the risk of teratogenicity and polyneuropathy. However, medical treatment with local corticosteroids remains the mainstay of CLE treatment, especially for DLE. Patient education regarding the disease is also important in the management of CLE, because it helps relieve undue anxiety and to recruit the patient as an active participant in the treatment regimen.
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Affiliation(s)
- Paolo Fabbri
- Department of Dermatological Sciences, University of Florence, Florence, Italy.
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Mandelcorn R, Shear NH. Lupus-associated toxic epidermal necrolysis: a novel manifestation of lupus? J Am Acad Dermatol 2003; 48:525-9. [PMID: 12664014 DOI: 10.1067/mjd.2003.107] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND Toxic epidermal necrolysis is an acute mucocutaneous reaction characterized by extensive cutaneous and mucosal sloughing and systemic involvement. It is generally associated with drug ingestion. OBJECTIVE AND METHODS We describe 2 patients who developed typical clinical and histopathologic features of toxic epidermal necrolysis with unusual subacute progression, absence of systemic involvement or high-risk drug ingestion, and features of lupus erythematosus. CONCLUSION We propose that this constellation of features represents a new entity not previously described. This entity may represent a more severe variant of Rowell's syndrome or, alternatively, a novel manifestation of lupus erythematosus
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Abstract
This article will review and update information about the pathogenesis, clinical presentation, diagnosis, and treatment of cutaneous lupus erythematosus. Lupus erythematosus (LE) can present as a skin eruption, with or without systemic disease. Cutaneous LE is subdivided into chronic cutaneous LE, subacute cutaneous LE and acute LE. The prevalence of systemic lupus erythematosus (SLE) is 17-48/100,000 population worldwide. Skin disease is one of the most frequent clinical complaints of patients suffering from SLE. It has been found to occur in up to 70% of patients during the course of the disease. The most frequent mucocutaneous manifestations of SLE are malar rash (40%), alopecia (24%), and oral ulcers (19%). It has been suggested that risk factors that are more likely to signal transition of cutaneous into systemic LE are high ANA titers (> 1:320) and the presence of arthralgias. CLE patients who exhibit these symptoms should be monitored closely, since they may be at increased risk to develop SLE.
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Cardinali C, Giomi B, Caproni M, Fabbri P. Maculopapular lupus rash in a young woman with systemic involvement. Lupus 2001; 9:713-6. [PMID: 11199928 DOI: 10.1191/096120300668126253] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We describe a 23-y-old woman with known systemic lupus erythematosus (SLE) who presented to us with the characteristic maculopapular lupus rash. Although well-known among the LE-specific skin lesions, this acute cutaneous manifestation is rarely reported.
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Affiliation(s)
- C Cardinali
- Department of Dermatological Sciences, University of Florence, Florence, Italy
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Abstract
A 19-year-old woman with a 6 month history of systemic lupus erythematosus (SLE) developed a widespread urticated, erythematous eruption associated with tense, fluid-filled blisters, erosions and crusting. Biopsy showed subepidermal blistering with a prominent neutrophilic infiltrate. Direct immunofluorescence showed markedly positive granular IgG deposition with weak IgM, IgA and C3 at the dermoepidermal junction. No circulating antibodies were detected on indirect immunofluorescence. A diagnosis of bullous systemic erythematosus was made. Treatment with prednisone was ineffective. Subsequent treatment with dapsone led to rapid sustained remission of skin symptoms. Bullous SLE is a rare manifestation of SLE. We review the recent literature and discuss the distinctive features of this condition and contrast them with cutaneous SLE with blisters and the subepidermal blistering disorders.
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Affiliation(s)
- A Yung
- Department of Dermatology, Waikato Hospital, Hamilton, New Zealand.
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Saeki Y, Ohshima S, Kurimoto I, Miura H, Suemura M. Maintaining remission of lupus erythematosus profundus (LEP) with cyclosporin A. Lupus 2000; 9:390-2. [PMID: 10878735 DOI: 10.1191/096120300678828406] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We report a young female patient with recurrent lupus erythematosus profundus (LEP) who has successfully maintained remission of LEP with cyclosporin A (CsA), although conventional treatments such as systemic corticosteroids (low-dose), dapsone, and other immunosuppressive drugs (azathiopurine, cyclophosphamide) could not maintain remission.
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Affiliation(s)
- Y Saeki
- Department of Molecular Medicine, Osaka University Medical School, Suita City, Japan.
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