Dermatology and Internal
Medicine Part-I
LUPUS ERYTHEMATOSUS
Personal Notes
1. Cutaneous LE
2. Systemic lupus erythematosus
Clinical Spectrum of Disease/Types:
1. Cutaneous Lupus Erythematosus (CLE):
| Acute, Sub-acute and Chronic forms
2. Systemic Lupus Erythematosus (SLE):
| Multi-organ involvement
3. Drug-Induced Lupus:
| Medication-induced, typically reversible
4. Neonatal Lupus:
In infants of mothers with specific autoantibodies.
CUTANEOUS LUPUS ERYTHEMATOSUS (CLE)
Acute Cutaneous Lupus Erythematosus (ACLE):
| Malar rash - sparing of naso - labial folds
Subacute Cutaneous LE (SCLE):
Personal Notes
| Psoriasiform lesions or annular lesions.
| Very photosensitive variant
Chronic Cutaneous LE (CCLE):
| Discoid LE
| Central atrophy & hyperpigmented border
| Scalp, forehead, ears, cheeks etc.
| Hyperpigmentation & scarring
| Carpet tack sign
| DLE - very adherent scaling
| Usually DLE does not have systemic symptoms.
| Purely cutaneous form
| 1-2% proceeds to SLE
204 Dermatology
Personal Notes
SYSTEMIC LUPUS ERYTHEMATOSUS
| Skin + multi organ involvement
| Malar rash
| Photosensitivity
| Aphthous ulcers (non - painful)
| Unruly hair - lupus hair
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| Rash Sparing interphalangeal joints
Personal Notes
| Lobular panniculitis + DLE/SLE → Lupus profundus
DRUG - INDUCED LUPUS ERYTHEMATOSUS
| Hydralazine
| Procainamide
| Isoniazid
| Anti - seizure medications
| In drug induced lupus erythematosus - anti histone antibodies are seen.
Neonatal Lupus:
|Mother who has anti - Ro/SSA antibodies
¯
Fetus
¯
Skin lesions + congenital heart block
Additional Findings in SLE - (SOAP BRAIN MD):
| S - Serositis - pleuritis, pericarditis
| O - Oral ulcers - non painful
| A - Arthritis
| P - Photosensitivity
| B - Blood disorders - anaemia, thrombocytopenia, leukopenia
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| R - Renal involvement
Personal Notes
| A - ANA positive
| I - Immunologic phenomena
| N - Neurologic disorders
| M - Malar rash/butterfly rash
| D - Discoid rash
Diagnosis of Lupus Erythematosus:
| 9:1 - female: male - manifestation of systemic lupus erythematosus.
| Classification criteria - 2019 EULAR/ACR criteria for SLE.
| Laboratory tests - ANA, anti - dsDNA, anti - Smith, anti - phospholipid antibodies,
complement levels.
| ANA - most sensitive test
| Cutaneous lupus - diagnosis based on clinical presentation, skin biopsy and direct
immunofluorescence.
Laboratory Tests and Indications in Lupus:
| ANA (antinuclear antibody) - most sensitive test
| Anti - dsDNA and anti - Smith (Sm) antibodies - most specific test
| Antiphospholipid antibodies - thrombosis, miscarriage/abortions
| Complement levels (C3, C4) - ¯ ¯
| Anti - Ro/SSA and anti - La/SSB antibodies - SLE & Sjogren syndrome, Neonatal lupus.
| Anti - U1 RNP - mixed connective tissue disorders
| Anti - histone antibodies - drug induced lupus
| Direct immunofluorescence (DIF) - lupus band
Treatment of Lupus Erythematosus:
| General approach - sun protection
| Mild disease - hydroxychloroquine, topical steroids
| Moderate to severe disease - oral steroids
| Severe disease - new therapy (biologics) like belimumab and anifrolumab.
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