Lupus erythematosusLupus erythematosus

Discoid lupus erythematosusDiscoid lupus erythematosus Systemic lupus erythematosusSystemic lupus erythematosus

Discoid Lupus erythematosusDiscoid Lupus erythematosus

Young adultYoung adult Women: men = 2:1Women: men = 2:1 Clinnical Findings :Clinnical Findings :

Dull red macule with adherent scale with Dull red macule with adherent scale with follicular plugging, which heal with atrophy, follicular plugging, which heal with atrophy, scarring and pigemantary changing, scarring and pigemantary changing, telangiekatasis.telangiekatasis.

Side: usually above the neck. Favorite are Side: usually above the neck. Favorite are scalp, bridges of the nose, malar areas, scalp, bridges of the nose, malar areas, lower lips and earslower lips and ears

Generalized dle is less common than Generalized dle is less common than localized DLE and is usually localized DLE and is usually suerimposed on alocallized discoid suerimposed on alocallized discoid case.case.

Progression from DLE to systemic Progression from DLE to systemic lupus erythematosus (SLE) is lupus erythematosus (SLE) is uncommon. uncommon.

Differential diagnosisDifferential diagnosis• Seborrheic dermatitisSeborrheic dermatitis• RosaceaRosacea• Lupus vulagrisLupus vulagris• SarcoidSarcoid• Drug eruptionDrug eruption

TreatmentTreatment• Avoid exposure to sunlight, excessive Avoid exposure to sunlight, excessive

cold, to heat and traumacold, to heat and trauma• Use a high SPF sun screenUse a high SPF sun screen• Local: Local:

potent or super potent corticosteroidpotent or super potent corticosteroid Intralesional triamsinolon acetonide 2,5 to Intralesional triamsinolon acetonide 2,5 to

10 mg/ml10 mg/ml

SystemicSystemic• Anti malarials. Hydroxychloroquine 6,5 Anti malarials. Hydroxychloroquine 6,5

mg/kg/day. Chloroquine 250 mg/daymg/kg/day. Chloroquine 250 mg/day• QuinacrineQuinacrine• Systemic corticosteroid for widespread Systemic corticosteroid for widespread

or disfuguring lesionor disfuguring lesion

Systemic Lupus ErythematosusSystemic Lupus Erythematosus

Young to middle aged womenYoung to middle aged women Skin involvement occurs in 80% of Skin involvement occurs in 80% of

casescases Diagnosis of SLE are based on four of Diagnosis of SLE are based on four of

the American Rheumatism the American Rheumatism Assosiation’s 11 criteriaAssosiation’s 11 criteria

Cutaneus manifestationCutaneus manifestation• Butterfly facial erythemmabullous lesionButterfly facial erythemmabullous lesion• Diffuse, non scarring hair lossDiffuse, non scarring hair loss• Mucous membrane lesion eq Mucous membrane lesion eq

conjunctivitis, episcleritis, vaginal ulcerconjunctivitis, episcleritis, vaginal ulcer• Leg ulcerLeg ulcer• Cutaneous angiitisCutaneous angiitis• Calcinosis cutisCalcinosis cutis

Systemic manifestationSystemic manifestation• ArthralgiaArthralgia• Renal involvementRenal involvement• MyocarditisMyocarditis• CNS involvement CNS involvement • VasculitisVasculitis• ConvulsionConvulsion• EpilepsyEpilepsy• RetinitisRetinitis• Idiopathic trombocytopenic purpuraIdiopathic trombocytopenic purpura

EtiologyEtiology• GeneticGenetic• Altered immune responAltered immune respon• Drugs such as hydralazine, procainamid, Drugs such as hydralazine, procainamid,

sulfonamid, penicillin, anticonvulsan, sulfonamid, penicillin, anticonvulsan, minocycline and isoniazidminocycline and isoniazid

Laboratory findingsLaboratory findings• Anemia hemolyticAnemia hemolytic• ThrombocytopeniaThrombocytopenia• LymphopeniaLymphopenia• LeukopeniaLeukopenia• Erythrocyte sedimentation rate is Erythrocyte sedimentation rate is

elevatedelevated• Coombs tes positifCoombs tes positif• Rgeumatoid factor positifRgeumatoid factor positif

Immulogic findingsImmulogic findings• ANA testANA test• LE cell testLE cell test• Ds DNADs DNA• Anti SM antibodyAnti SM antibody• Lupus band testLupus band test• ANA patternANA pattern

Differential diagnosisDifferential diagnosis• DermtaomyositisDermtaomyositis• Toxic erytema multiformeToxic erytema multiforme• Acute rheumatoid feverAcute rheumatoid fever• Drug eruptionDrug eruption• Sjogren’s syndromeSjogren’s syndrome

TreatmentTreatment• Avoid exposure to sunlight and use a high SPF Avoid exposure to sunlight and use a high SPF

sun screensun screen• Antimalarial: hydroxychlotoquin or chloroquinAntimalarial: hydroxychlotoquin or chloroquin• Corticosteroid: 1000 mg of prednisolone IV Corticosteroid: 1000 mg of prednisolone IV

daily for 3 days , followed bt oraal prednisone daily for 3 days , followed bt oraal prednisone 0,5 to 1 mg/kg/dailly0,5 to 1 mg/kg/dailly

• Immunosuppressive therapy: azathiopreine, Immunosuppressive therapy: azathiopreine, methotrexate and cyclophosphamidemethotrexate and cyclophosphamide

1982 ACR (Revised 1997) SLE 1982 ACR (Revised 1997) SLE Classification CriteriaClassification Criteria

1.1. Malar (butterfly) rashMalar (butterfly) rash2.2. Discoid lesionsDiscoid lesions3.3. PhotosensitivityPhotosensitivity4.4. Oral ulcersOral ulcers5.5. Non-deforming arthritis (non-erosive for the most part)Non-deforming arthritis (non-erosive for the most part)6.6. Serositis: pleuropericarditis, aseptic peritonitisSerositis: pleuropericarditis, aseptic peritonitis7.7. Renal: persistent proteinuria › 0.5 g/d or ›3+ or cellular Renal: persistent proteinuria › 0.5 g/d or ›3+ or cellular

castscasts8.8. Neurologic disorders: seizures, psychosisNeurologic disorders: seizures, psychosis9.9. Heme: hemolytic anemia; leukopenia, thrombocytopeniaHeme: hemolytic anemia; leukopenia, thrombocytopenia10.10. Immune: anti-DNA, or anti-Sm, or APS (ACA IgG, IgM), or Immune: anti-DNA, or anti-Sm, or APS (ACA IgG, IgM), or

lupus anticoagulant (standard) or false + RPRlupus anticoagulant (standard) or false + RPR11.11. Positive FANA (fluorescent antinuclear antibody)Positive FANA (fluorescent antinuclear antibody)

SLE-Clinical and Laboratory FeaturesSLE-Clinical and Laboratory Features Musculoskeletal Musculoskeletal 90%90% SkinSkin 80%80% RenalRenal 50%50% CNSCNS 15%15% Severe thrombocytopeniaSevere thrombocytopenia

5-10%5-10% Positive ANAPositive ANA 95+% 95+%

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

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

Jaccoud’s arthropathy

Arthritis in lupus can bedeforming but is typically

non-erosive!