ACUTE COETANEOUS LUPUS ERYTHEMATOSUS

ACUTE COETANEOUS LUPUS ERYTHEMATOSUS

•         ACLE  :

Localized

–         characterized by confluent symmetric erythematic and edema centered over the malar eminences The nasolabial folds are typically spared. (malar rash ).

–         The forehead and V-area of the neck can be similarly involved.

•         Generalized

      ( photosensitive lupus dermatitis” )

• ACLE begins on the face as small, discrete macular, or papular lesions, or both, that later become confluent and hyperkeratosis
• Generalized ACLE, a less common variety, presents as a more widespread morbilliform or exanthemata eruption
• ACLE that can stimulate toxic epidermal necrolysis
• strong association between ACLE and systemic LE activity,

•         ACLE  :photosensitive , transient, lasting only several days or weeks.

•         Post inflammatory pigmentary change is most prominent in patients with LE with darkly pigmented skin

•         ACLE lesions do not result in scarring.

•         Superficial ulceration of the oral or nasal mucosa is a frequent accompaniment of ACLE

•         The posterior areas of the hard palate are most commonly affected, however, the labial, gingival, buccal, and lingual mucosa may also be involved. In the early stages of such lesions,

•         the pathology is usually nonspecific;

SUBACUTE CUTANEOUS LUPUS ERYTHEMATOSUS

•         SCLE skin lesions including

–         symmetric erythema centrifugum,

–         disseminated DLE,

–          autoimmune annular erythema,

–         subacute disseminated in LE,

–         superficial disseminated LE,

–         psoriasiform LE, pityriasiform LE, and

–         maculopapular photosensitive LE

•         SCLE consists of non scarring papulosquamous or annular skin lesions

•         LE-specific histopathology and occur in a characteristic photo-distribution

•         a higher frequency of anti-Ro (SS-a) antibody positivity

•         SCLE lesions :

•          sun-exposed areas : upper back, shoulders, extensor aspects of the arms, V-area of the neck, and less commonly, on the face

•         Infrequently, SCLE lesions present initially with any appearance of erythema multiforme

•         Lesions typically heal without scarring