1. “Systemic Lupus Erythematosus” Cutaneous features
Iraj Salehi-Abari
“Systemic Lupus Erythematosus” Cutaneous features
Iraj Salehi-Abari MD.,
Internist
Rheumatologist
SLE

2. Definition: Chronic disease Systemic/Multi-organ disease
Iraj Salehi-Abari
Definition:
Chronic disease
Systemic/Multi-organ disease
Inflammatory/Autoimmune disease
Autoantibody/Immune Complex
Skin, Joints, Kidneys, Lungs, Nervous system, Serous membranes,… y
SLE

3. Cutaneous features: Skin involvement: > 80%
Iraj Salehi-Abari
Cutaneous features:
Skin involvement: > 80%
DD with all skin diseases
Erythemato-desquamation
Photosensitive: %
Acute/subacute/chronic
Localized/generalized
SLE

4. Iraj Salehi-Abari
Cutaneous features:
SLE

5. Acute Cutaneous Lupus Erythematosus (ACLE) : Localized, “Malar rash”

6. Acute Cutaneous Lupus Erythematosus (ACLE) : Localized
Iraj Salehi-Abari
Acute Cutaneous Lupus Erythematosus (ACLE) : Localized
Malar rash (“Butterfly rash”): 50%
Usually after UV light exposure
Mistaken for a sunburn
Warm, edematous, peau d’ orange
Sunscreens  enhance the redness of rash
SLE

7. Malar rash (“Butterfly rash”): 50% Usually after UV light exposure
Iraj Salehi-Abari
Malar rash (“Butterfly rash”): 50%
Usually after UV light exposure
Mistaken for a sunburn
Warm, edematous, peau d’ orange
Sunscreens  enhance the redness of rash
SLE

8. Acute Cutaneous Lupus Erythematosus (ACLE) : Generalized
Iraj Salehi-Abari
Acute Cutaneous Lupus Erythematosus (ACLE) : Generalized
Maculopapular lupus rash
Sun-exposed area type
Erythrodermic type
Bullous lupus rash
Toxic epidermal necrolysis variant of SLE
Periungual telangiectasia
SLE

9. Subacute Cutaneous Lupus Erythematosus (SCLE): Psoriaform and/or annular lesions

10. Subacute Cutaneous Lupus Erythematosus (SCLE):
Iraj Salehi-Abari
Subacute Cutaneous Lupus Erythematosus (SCLE):
There are two clinical forms:
Papulosquamous (“Psoriasiform”) form
“Annular” form
Skin areas:
Shoulder, forearms, neck and upper torso
50% of SCLE have SLE
10% of SLE have SCLE
SLE

11. Chronic Cutaneous Lupus Erythematosus (CCLE):
Iraj Salehi-Abari
Chronic Cutaneous Lupus Erythematosus (CCLE):
Discoid Lupus Erythematosus (“DLE”):
A scaly plaque with follicular plugging, central scar and atrophy, telangiectasias and hyper/hypo-pigmentation
Localized DLE: above the neck
Generalized DLE: above and below the neck
10-15% of DLE  SLE
Up to 25% of SLE  DLE
SLE

14. Chronic Cutaneous Lupus Erythematosus (CCLE):
Iraj Salehi-Abari
Chronic Cutaneous Lupus Erythematosus (CCLE):
Hypertrophic (verrucous) lupus
Lupus panniculitis (profundus)
Lupus erythematosus tumidus
Chilblains lupus
DLE/Lichen planus overlap
SLE

15. Vascular skin lesions of SLE:
Iraj Salehi-Abari
Vascular skin lesions of SLE:
Periungual erythema and telangiectasia
Livedo reticularis
Facial telangiectasia
Raynaud phenomenon
Petechia/purpura
SLE

16. Vascular skin lesions of SLE:
Iraj Salehi-Abari
Vascular skin lesions of SLE:
Microinfarcts of the tips of fingers and toes
Splinter hemorrhages
“Janeway lesion”
“Osler’s nodes”
Atrophie blanche
Chilblain Lupus Erythematosus (CHLE)
SLE

17. Vascular skin lesions of SLE:
Iraj Salehi-Abari
Vascular skin lesions of SLE:
Microinfarcts of the tips of fingers and toes
Splinter hemorrhages
“Janeway lesion”
“Osler’s nodes”
Atrophie blanche
Chilblain Lupus Erythematosus (CHLE)
SLE

18. Iraj Salehi-Abari
Photosensitivity:
An abnormal dermal erythema response after exposure to ultraviolet (UV) radiation such as sunshine,…
60-100% of cases, UV-B > UV-A
Blonde, blue-eyed, fair-skinned > Brunettes > Blacks
SLE

19. Nail lesions: Nail pitting, ridging and onycholysis: 25%
Iraj Salehi-Abari
Nail lesions:
Nail pitting, ridging and onycholysis: 25%
Periungual telangiectasia and erythema
Half-moon (lunula) redness: 20%
SLE

20. Hair loss (Alopecia): Majority of patients, some time during illness
Iraj Salehi-Abari
Hair loss (Alopecia):
Majority of patients, some time during illness
One or more areas of scalp, eyebrows, eyelashes, beard and body hair
Scarring alopecia of scalp: DLE
Nonscarring alopecia: “Lupus hair”
SLE

21. Iraj Salehi-Abari
Hair loss (Alopecia):
SLE

22. Mucousal lesions: Oral ulcer: painless, superficial erosion
Iraj Salehi-Abari
Mucousal lesions:
Oral ulcer: painless, superficial erosion
Nasal ulcer
Labial DLE
Other oral lesions: white plaques, silvery scarred lesion, areas of erythema, aphthous ulcer, vesicular lesions and gingivitis
SLE

23. Iraj Salehi-Abari
Mucousal lesions:
SLE