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LETTER TO EDITOR
Year : 1995  |  Volume : 61  |  Issue : 4  |  Page : 240-241

Subacute cutaneous lupus erythematosus



Correspondence Address:
S Shubhada Javadekar


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Source of Support: None, Conflict of Interest: None


PMID: 20952973

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How to cite this article:
Javadekar S S. Subacute cutaneous lupus erythematosus. Indian J Dermatol Venereol Leprol 1995;61:240-1

How to cite this URL:
Javadekar S S. Subacute cutaneous lupus erythematosus. Indian J Dermatol Venereol Leprol [serial online] 1995 [cited 2019 Jun 19];61:240-1. Available from: http://www.ijdvl.com/text.asp?1995/61/4/240/4226



  To the Editor, Top


A 35-year-old woman presented with itchy, slowly progressive, erythematous discoid plaques ranging from 1 cm to 4 cm in diameter present over, left pinna, tip of nose and alae nasi, left cheek, upper chest, upper back and left forearm for the past 6 months.

Most of the lesions showed atrophic surface with depigmentation, coarse adherant scales and plugged follicular orifices, while the lesions on the upper back were annular with mild pigmentary changes and fine scaling. Scalp showed a non-scarring skin-coloured plaque, about lcm x 4cm in size, with uneven surface and prominent follicular orifices. Tintack sign was positive.

Associated complaints were increased itching and redness over plaques on sun exposure, anorexia, on and off vertigo, persistent joint pain in elbows, wrists, knees and ankles, and cyanosis of fingers with swelling and pain on dipping in cool water, which got relieved on warming.

The following investigations revealed significant results: ESR 58 mm in 1st hour, 24 hour urinary protein 300 mg, RA factor positive, anti-nuclear antibody and anti-DNA antibody positive (0.092 and 50.6 IU/ml, respectively). Histopathological report of a biopsy taken from an annular plaque was consistent with the diagnosis of lupus erythematosus.

Gilliam in 1977 added a clinically distinct subset, subacute cutaneous lupus erythematosus (SCLE), to the spectrum of lupus erythematosus.[1] About half of the patients with SCLE fulfill the ARA criteria for the diagnosis of systemic lupus erythematosus (SLE), as was the case with our patient. The characteristic clinical features of SCLE are: (a) The type of lesions which are either non-scarring papulosquamous or annular or polycyclic; (b) The distribution: the lesions are usually located above the waist and particularly around the neck, on the back and front of the trunk and on the outer aspects of the arm and dorsum of the hands.[2] SCLE may be divided into two sub-sets according to clinical features: a "papulosquamous or psoriasis-like variety" appearing as erythematous papillary lesions with a scaly surface and an "annular polycyclic variety" with peripherally expanding annular or polycyclic lesions. Sometimes both patterns are seen in the same patient but one is usually predominant.[3] Localized scarring discoid lupus erythematosus-like lesions are found in about 20% of SCLE patients.[3] Our patient had such lesions on the front of chest.

Diagnosis of SCLE is important because these patients have a better prognosis than those with SLE and need to be managed less aggressively.[4] The patient is being treated with photoprotection, topical augmented betamethasone dipropionate and non-steroidal anti-inflammatory drugs. She has responded well in about a month. The scaling and induration of the lesions have markedly subsided and joint pain has lessened. This appears to be the first case of SCLE reported from India.

 
  References Top

1.Gilliam JN. The cutaneous signs of lupus erythematosus. Contin Educ Fam Rhys 1977;6:34-40.  Back to cited text no. 1    
2.Yancey KB, Lawley TJ. Immunologically mediated skin diseases. In: Harrison's Principles of Internal Medicine (Isselbacher KJ, Braunwald E, Wilson JD, et al, eds). 13th edn. New York: McGraw-Hill, 1994;289.  Back to cited text no. 2    
3.Luger TA, Benesch D. Cutaneous manifestations. In: Systemic Lupus Erythematosus: Clinical and Experimental Aspects (Smolen JS, Zielenski CC, eds). 1st edn. Berlin: Springer-Verlag, 1987;234-5.  Back to cited text no. 3    
4.Rowell NR, Goodfield MJD. The "connective tissue diseases". In: Textbook of Dermatology (Champion RH, Burton JL, Ebling FJG, eds). 5th edn. London: Blackwell Scientific Publications, 1992;2186-7.  Back to cited text no. 4    




 

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