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The family physician diagnosed chronic cutaneous lupus erythematosus (discoid lupus).
After noting that the rash was malar and spared the nasolabial folds, the physician ordered an antinuclear antibody (ANA) test and performed a punch biopsy. The ANA was positive at a 1:80 dilution. A homogeneous nuclear pattern was present, as is commonly seen in systemic lupus erythematosus (SLE) and drug-induced lupus. The punch biopsy of a facial lesion was consistent with chronic cutaneous lupus erythematosus. The comprehensive chemistry panel and complete blood count were normal.
Cutaneous lupus is twice as common in women than men. Patients with cutaneous lupus have a 5% to 10% risk of eventually developing SLE, which tends to follow a mild course. Cutaneous lupus lesions usually slowly expand (with active inflammation at the periphery) and then heal, leaving depressed central scars, atrophy, telangiectasias, and hypopigmentation.
Topical steroids did not provide this patient with relief, so she was started on a short course of systemic steroids. Three weeks later, there was improvement (FIGURE 2). Hyperpigmentation remained, but the erythema, swelling, pain, and pruritus were gone.
Photos and text for Photo Rounds Friday courtesy of Richard P. Usatine, MD. This case was adapted from: Mayeaux, EJ. Lupus erythematosus (systemic and cutaneous). In: Usatine R, Smith M, Mayeaux EJ, et al, eds. The Color Atlas of Family Medicine. New York, NY: McGraw-Hill; 2009:766-771.
To learn more about The Color Atlas of Family Medicine, see:
* http://www.amazon.com/Color-Atlas-Family-Medicine/dp/0071474641
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The family physician diagnosed chronic cutaneous lupus erythematosus (discoid lupus).
After noting that the rash was malar and spared the nasolabial folds, the physician ordered an antinuclear antibody (ANA) test and performed a punch biopsy. The ANA was positive at a 1:80 dilution. A homogeneous nuclear pattern was present, as is commonly seen in systemic lupus erythematosus (SLE) and drug-induced lupus. The punch biopsy of a facial lesion was consistent with chronic cutaneous lupus erythematosus. The comprehensive chemistry panel and complete blood count were normal.
Cutaneous lupus is twice as common in women than men. Patients with cutaneous lupus have a 5% to 10% risk of eventually developing SLE, which tends to follow a mild course. Cutaneous lupus lesions usually slowly expand (with active inflammation at the periphery) and then heal, leaving depressed central scars, atrophy, telangiectasias, and hypopigmentation.
Topical steroids did not provide this patient with relief, so she was started on a short course of systemic steroids. Three weeks later, there was improvement (FIGURE 2). Hyperpigmentation remained, but the erythema, swelling, pain, and pruritus were gone.
Photos and text for Photo Rounds Friday courtesy of Richard P. Usatine, MD. This case was adapted from: Mayeaux, EJ. Lupus erythematosus (systemic and cutaneous). In: Usatine R, Smith M, Mayeaux EJ, et al, eds. The Color Atlas of Family Medicine. New York, NY: McGraw-Hill; 2009:766-771.
To learn more about The Color Atlas of Family Medicine, see:
* http://www.amazon.com/Color-Atlas-Family-Medicine/dp/0071474641
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|
The family physician diagnosed chronic cutaneous lupus erythematosus (discoid lupus).
After noting that the rash was malar and spared the nasolabial folds, the physician ordered an antinuclear antibody (ANA) test and performed a punch biopsy. The ANA was positive at a 1:80 dilution. A homogeneous nuclear pattern was present, as is commonly seen in systemic lupus erythematosus (SLE) and drug-induced lupus. The punch biopsy of a facial lesion was consistent with chronic cutaneous lupus erythematosus. The comprehensive chemistry panel and complete blood count were normal.
Cutaneous lupus is twice as common in women than men. Patients with cutaneous lupus have a 5% to 10% risk of eventually developing SLE, which tends to follow a mild course. Cutaneous lupus lesions usually slowly expand (with active inflammation at the periphery) and then heal, leaving depressed central scars, atrophy, telangiectasias, and hypopigmentation.
Topical steroids did not provide this patient with relief, so she was started on a short course of systemic steroids. Three weeks later, there was improvement (FIGURE 2). Hyperpigmentation remained, but the erythema, swelling, pain, and pruritus were gone.
Photos and text for Photo Rounds Friday courtesy of Richard P. Usatine, MD. This case was adapted from: Mayeaux, EJ. Lupus erythematosus (systemic and cutaneous). In: Usatine R, Smith M, Mayeaux EJ, et al, eds. The Color Atlas of Family Medicine. New York, NY: McGraw-Hill; 2009:766-771.
To learn more about The Color Atlas of Family Medicine, see:
* http://www.amazon.com/Color-Atlas-Family-Medicine/dp/0071474641