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Sprow G, Afarideh M, Dan J, Hedberg ML, Werth VP. Bullous systemic lupus erythematosus in females. Int J Womens Dermatol 2022; 8:e034. [PMID: 35923586 PMCID: PMC9324630 DOI: 10.1097/jw9.0000000000000034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 06/06/2022] [Indexed: 11/30/2022] Open
Abstract
Bullous systemic lupus erythematosus (BSLE) is a rare blistering presentation of systemic lupus erythematosus, typically affecting women with the highest incidence in those of African descent. The key pathogenic insult includes the formation of autoantibodies against type VII collagen, which weaken the basement membrane zone and lead to the formation of subepidermal blisters. The acute vesiculobullous eruptions in BSLE generally tend to affect photo-distributed areas, although they can arise unrelated to sun exposure (eg, mucous membranes, axillae). The bullae can arise from erythematous macules, inflammatory plaques, or previously normal skin. Their appearance can range from small, grouped vesicles reminiscent of lesions in dermatitis herpetiformis to large, tense blisters, similar to bullous pemphigoid. Internal organ involvement occurs in up to 90% of those affected. This mostly includes lupus nephritis (classes III–V, lifetime prevalence of up to 90%), arthralgias/arthritis, and cytopenias, while serositis and neuropsychiatric involvement are rare. First-line management with dapsone should be considered in mild disease with stable underlying systemic lupus erythematosus. As discussed in this review, the off-label use of rituximab (an anti-CD20 B-cell depleting agent) has been shown to be safe and effective in several refractory cases of BSLE unresponsive to dapsone, glucocorticoids, or steroid-sparing immunosuppressants.
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Torres Saavedra FA, Campo LR, Mendez MV, Barreneche NM, Suaza GAV, Restrepo JDR, Martinez-Gomez M. Bullous lupus as the first manifestation of systemic lupus erythematosus in the pediatric population: A diagnostic challenge in daily practice. Lupus 2020; 29:1937-1942. [PMID: 32842868 DOI: 10.1177/0961203320950814] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION In the GLADEL cohort, the bullous lupus (BSLE) prevalence was 0.41%. However, literature on pediatric BSLE is scarce. This study described the clinical, histological, and immunological characteristics and the treatment response in a series of children with BSLE as the first clinical manifestation of pediatric SLE. METHODS The clinical, histological, and immunological characteristics of a series of 5 cases of BSLE between 2010-2019 from two reference centers in Colombia were analyzed. RESULTS All cases had bullous lesions that resolved with residual hypopigmentation. One had a focal seizure, and another arthritis with thrombocytopenia. Two had transient proteinuria with normal urinalysis. Anti-nuclear antibody titers ranged from 1:160 to 1:2560, and four were anti-dsDNA (+). Five patients had anti-RNP antibodies, and four anti-Sm antibodies. All had low C3, and 80% low C4 counts; 80% had erythrocyte sedimentation rate (ESR) ≥20 mm/hour and 60% had C-reactive protein (CRP) ≥0.5 mg/dL. All patients responded to glucocorticoids and dapsone. Histology reports and direct immunofluorescence (DIF) test showed subepidermal blisters with neutrophils in the papillary dermis and linear deposits of Igs/complement proteins in 80% of the skin biopsies. IgG/IgM was present in 5 samples. IgA was positive in 60% and C3 in 80%. CONCLUSIONS In this pediatric series, BSLE tends to have a monophasic behavior associated with neuropsychiatric, skeletal, and hematological involvement in 40% of the patients, and with good prognosis.
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Affiliation(s)
- Fabio Andrés Torres Saavedra
- Rheumatology Group GRUA, Department of Internal Medicine, Facultad de Medicina, Universidad de Antioquia, Medellín, Colombia.,Hospital Universitario San Vicente Fundación, Medellín, Colombia
| | - Lyna Ramirez Campo
- Rheumatology Group GRUA, Department of Internal Medicine, Facultad de Medicina, Universidad de Antioquia, Medellín, Colombia.,Hospital Universitario Fundación Valle del Lili, Cali, Colombia
| | - Monica Velasquez Mendez
- Rheumatology Group GRUA, Department of Internal Medicine, Facultad de Medicina, Universidad de Antioquia, Medellín, Colombia.,Hospital Universitario San Vicente Fundación, Medellín, Colombia
| | - Natalia Mejia Barreneche
- Hospital Universitario San Vicente Fundación, Medellín, Colombia.,Dermatological Research Center CIDERM, Service of Dermatology, Facultad de Medicina, Universidad de Antioquia, Medellín, Colombia
| | - Gloria Andrea Vargas Suaza
- Hospital Universitario San Vicente Fundación, Medellín, Colombia.,Dermatological Research Center CIDERM, Service of Dermatology, Facultad de Medicina, Universidad de Antioquia, Medellín, Colombia
| | - Juan David Ruiz Restrepo
- Hospital Universitario San Vicente Fundación, Medellín, Colombia.,Dermatological Research Center CIDERM, Service of Dermatology, Facultad de Medicina, Universidad de Antioquia, Medellín, Colombia
| | - Manuel Martinez-Gomez
- Hospital Universitario San Vicente Fundación, Medellín, Colombia.,Dermatological Research Center CIDERM, Service of Dermatology, Facultad de Medicina, Universidad de Antioquia, Medellín, Colombia
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