Lupus Eritematous

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  • Lupus erythematosusDiscoid lupus erythematosusSystemic lupus erythematosus

  • 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

  • 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.

  • Differential diagnosisSeborrheic dermatitisRosaceaLupus vulagrisSarcoidDrug eruption

  • 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

  • SystemicAnti malarials. Hydroxychloroquine 6,5 mg/kg/day. Chloroquine 250 mg/dayQuinacrineSystemic corticosteroid for widespread or disfuguring lesion

  • 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

  • Cutaneus manifestationButterfly facial erythemmabullous lesionDiffuse, non scarring hair lossMucous membrane lesion eq conjunctivitis, episcleritis, vaginal ulcerLeg ulcerCutaneous angiitisCalcinosis cutis

  • Systemic manifestationArthralgiaRenal involvementMyocarditisCNS involvement VasculitisConvulsionEpilepsyRetinitisIdiopathic trombocytopenic purpura

  • EtiologyGeneticAltered immune responDrugs such as hydralazine, procainamid, sulfonamid, penicillin, anticonvulsan, minocycline and isoniazid

  • Laboratory findingsAnemia hemolyticThrombocytopeniaLymphopeniaLeukopeniaErythrocyte sedimentation rate is elevatedCoombs tes positifRgeumatoid factor positif

  • Immulogic findingsANA testLE cell testDs DNAAnti SM antibodyLupus band testANA pattern

  • Differential diagnosisDermtaomyositisToxic erytema multiformeAcute rheumatoid feverDrug eruptionSjogrens syndrome

  • 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

  • 1982 ACR (Revised 1997) SLE Classification Criteria

    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)

  • SLE-Clinical and Laboratory FeaturesMusculoskeletal 90%Skin80%Renal50%CNS15%Severe thrombocytopenia 5-10%Positive ANA 95+%

    Also, cardiopulmonary involvement, thrombotic tendency (APS), and premature or accelerated atherosclerosis!

  • Joint involvement in lupus mimics rheumatoid arthritis (RA) but milder

  • Jaccouds arthropathy

  • Arthritis in lupus can bedeforming but is typicallynon-erosive!