Lupus Eritematous

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<ul><li><p>Lupus erythematosusDiscoid lupus erythematosusSystemic lupus erythematosus</p></li><li><p>Discoid Lupus erythematosusYoung adultWomen: men = 2:1Clinnical Findings :Dull red macule with adherent scale with follicular plugging, which heal with atrophy, scarring and pigemantary changing, telangiekatasis.Side: usually above the neck. Favorite are scalp, bridges of the nose, malar areas, lower lips and ears</p></li><li><p>Generalized dle is less common than localized DLE and is usually suerimposed on alocallized discoid case.Progression from DLE to systemic lupus erythematosus (SLE) is uncommon. </p></li><li><p>Differential diagnosisSeborrheic dermatitisRosaceaLupus vulagrisSarcoidDrug eruption</p></li><li><p>TreatmentAvoid exposure to sunlight, excessive cold, to heat and traumaUse a high SPF sun screenLocal: potent or super potent corticosteroidIntralesional triamsinolon acetonide 2,5 to 10 mg/ml</p></li><li><p>SystemicAnti malarials. Hydroxychloroquine 6,5 mg/kg/day. Chloroquine 250 mg/dayQuinacrineSystemic corticosteroid for widespread or disfuguring lesion</p></li><li><p>Systemic Lupus ErythematosusYoung to middle aged womenSkin involvement occurs in 80% of casesDiagnosis of SLE are based on four of the American Rheumatism Assosiations 11 criteria</p></li><li><p>Cutaneus manifestationButterfly facial erythemmabullous lesionDiffuse, non scarring hair lossMucous membrane lesion eq conjunctivitis, episcleritis, vaginal ulcerLeg ulcerCutaneous angiitisCalcinosis cutis</p></li><li><p>Systemic manifestationArthralgiaRenal involvementMyocarditisCNS involvement VasculitisConvulsionEpilepsyRetinitisIdiopathic trombocytopenic purpura</p></li><li><p>EtiologyGeneticAltered immune responDrugs such as hydralazine, procainamid, sulfonamid, penicillin, anticonvulsan, minocycline and isoniazid</p></li><li><p>Laboratory findingsAnemia hemolyticThrombocytopeniaLymphopeniaLeukopeniaErythrocyte sedimentation rate is elevatedCoombs tes positifRgeumatoid factor positif</p></li><li><p>Immulogic findingsANA testLE cell testDs DNAAnti SM antibodyLupus band testANA pattern</p></li><li><p>Differential diagnosisDermtaomyositisToxic erytema multiformeAcute rheumatoid feverDrug eruptionSjogrens syndrome</p></li><li><p>TreatmentAvoid exposure to sunlight and use a high SPF sun screenAntimalarial: hydroxychlotoquin or chloroquinCorticosteroid: 1000 mg of prednisolone IV daily for 3 days , followed bt oraal prednisone 0,5 to 1 mg/kg/daillyImmunosuppressive therapy: azathiopreine, methotrexate and cyclophosphamide</p></li><li><p>1982 ACR (Revised 1997) SLE Classification Criteria</p><p>Malar (butterfly) rashDiscoid lesionsPhotosensitivityOral ulcersNon-deforming arthritis (non-erosive for the most part)Serositis: pleuropericarditis, aseptic peritonitisRenal: persistent proteinuria 0.5 g/d or 3+ or cellular castsNeurologic disorders: seizures, psychosisHeme: hemolytic anemia; leukopenia, thrombocytopeniaImmune: anti-DNA, or anti-Sm, or APS (ACA IgG, IgM), or lupus anticoagulant (standard) or false + RPRPositive FANA (fluorescent antinuclear antibody)</p></li><li><p>SLE-Clinical and Laboratory FeaturesMusculoskeletal 90%Skin80%Renal50%CNS15%Severe thrombocytopenia 5-10%Positive ANA 95+%</p><p>Also, cardiopulmonary involvement, thrombotic tendency (APS), and premature or accelerated atherosclerosis!</p></li><li><p>Joint involvement in lupus mimics rheumatoid arthritis (RA) but milder</p></li><li><p>Jaccouds arthropathy</p></li><li><p>Arthritis in lupus can bedeforming but is typicallynon-erosive!</p></li></ul>