Lupus Erythematosus The cutaneous manifestations of lupus erythematosus (LE) (Chap. 313) can be divided into acute, subacute, and chronic types. Acute cutaneous LE is characterized by erythema of the nose and malar eminences in a "butterfly" distribution (Fig. 55-5). The erythema is often sudden in onset, accompanied by edema and fine scale, and correlated with systemic involvement. Patients may have widespread involvement of the face as well as erythema and scaling of the extensor surfaces of the extremities and upper chest. These acute lesions, while sometimes evanescent, usually last for days and are often associated with exacerbations of systemic. | Chapter 055. Immunologically Mediated Skin Diseases Part 8 Lupus Erythematosus The cutaneous manifestations of lupus erythematosus LE Chap. 313 can be divided into acute subacute and chronic types. Acute cutaneous LE is characterized by erythema of the nose and malar eminences in a butterfly distribution Fig. 55-5 . The erythema is often sudden in onset accompanied by edema and fine scale and correlated with systemic involvement. Patients may have widespread involvement of the face as well as erythema and scaling of the extensor surfaces of the extremities and upper chest. These acute lesions while sometimes evanescent usually last for days and are often associated with exacerbations of systemic disease. Skin biopsy of acute lesions may show only a sparse dermal infiltrate of mononuclear cells and dermal edema. In some instances cellular infiltrates around blood vessels and hair follicles are notable as is hydropic degeneration of basal cells of the epidermis. Direct immunofluorescence microscopy of lesional skin frequently reveals deposits of immunoglobulin s and complement in the epidermal basement membrane zone. Treatment is aimed at control of systemic disease photoprotection in this as well as in other forms of LE is very important. Figure 55-5 A. Acute cutaneous lupus erythematosus showing prominent scaly malar erythema. Involvement of other sun-exposed sites is also common. B. Acute cutaneous LE on the upper chest demonstrating brightly erythematous and slightly edematous papules and plaques. B Courtesy of Robert Swerlick MD. Subacute cutaneous lupus erythematosus SCLE is characterized by a widespread photosensitive nonscarring eruption. Most of these patients have SLE in which renal and central nervous system involvement is mild or absent. SCLE may present as a papulosquamous eruption that resembles psoriasis or annular lesions that resemble those seen in erythema multiforme. In the papulosquamous form discrete erythematous papules arise on the back chest .
