Refrence books Harrison 21st edition Neena Khanna 4th edition

1. SLE- SYSTEMIC
LUPUS
ERYTHEMATOUS
2197-Samiksha Tandon

2. COMPETENCY
DR 16.1 Identify and distinguish
skin lesions of SLE.
REFERENCE-
HARRISON`S 21st EDITION
NEENA KHANNA 4TH EDITION

3. TRIGGERS
 Ultraviolet radiation: Exposure to Sunlight or
Artificial light is frequently associated with
aggravation of lesions.
 Drugs: Several drugs (Procainamide, Hydralazine,
Isoniazid, Chlorpromazine, and Dilantin)are implicated
in inducing SLE.
Viral infections: Virus-like particles have been
demonstrated
in endothelial cells of lesional skin by electron
microscopy.

4. CUTANEOUS LESIONS-
lesions seen mainly on the photo-exposed
parts
LE-specific lesions
1. Butterfly Rash
2. Papulosquamous
lesions on photo-
exposed parts.
3. DLE-like discoid lesions.
4. Photosensitivity.
LE nonspecific lesions
1. Vascular lesions:
• Periungual telangiectasia and
ragged cuticles.
• Vasculitic lesions.
• Raynaud’s phenomenon and
sclerodactyly.
2. Oral ulcers
3. Alopecia: especially at the
frontal margin of the scalp; the
hair is lusterless, short and
broken (lupus hair).

5. Lupus dermatitis can be classified as acute,
subacute, or chronic.
ACUTE- BUTTERFLY RASH - photosensitive, slightly raised, occasionally
scaly erythema on the face (particularly the cheeks and nose), ears, chin, V
region of the neck and chest , upper back, and extensor surfaces of the
arms. Worsening of this rash often accompanies flare of systemic disease.

6. SUBACUTE- Consists of scaly red patches, similar to psoriasis,
or circular, flat, red-rimmed (“annular”) lesions. Patients with these
manifestations are exquisitely photosensitive;

7. CHRONIC- Discoid lupus erythematosus (DLE): lesions are roughly
circular with slightly raised, scaly, hyperpigmented erythematous rims and
depigmented,
atrophic centers in which all dermal appendages are permanently
destroyed.
Lesions can be disfiguring, particularly on the face and scalp. Only 5% of
people with DLE have SLE (although half have positive ANA); however,
among individuals with SLE, as many as 20% have DLE.

8. Lesions on dorsum of digits
sparing knuckles
Lupus hair which is short,
lusterless hair in the frontal
area.

9. CONFIRMING DIAGNOSIS OF SLE: BIOPSY
Histopathology Immunohistology
A positive Lupus Band Tes
is diagnostic of LE.
Lupus band test: (LBT):
Conventionally, LBT is said
to be positive if
immunoreactants are
deposited in linear band at
dermo-epidermal junction
in non lesional skin.

10. SLE should be differentiated from:
a. Polymorphous light eruption (PMLE)

11. b. Dermatomyositis

12. Treatment of Skin Lesions :
Conservative Management
• Photoprotection- Avoidance of exposure to sunlight especially at noon
is important [the midnoon Sun is the strongest].
• Sunscreens( of sun protecting factor atleast 30) should be advocated in
all patients [sunscreens are advised to be applied regularly at 3–4 h
intervals to be effective. Generally recommend to apply sunscreen at 8
AM, 12 noon, and 4 PM. Fluorescent tubes and energy saving lights,
which are frequently used for lighting , emit UVA. So, sunscreens need
to be used even after sunset, and even when indoors].
• Wearing of tightly woven clothing and broad rimmed hats.

13. Medical Treatment
• Topical Glucocorticoids and Antimalarials (such as
Hydroxychloroquine)
are effective in reducing lesion severity in most patients and are
relatively safe.
• Extensive, pruritic, bullous, or ulcerating dermatitis usually improve
promptly after institution of systemic Glucocorticoids -tapering may
be accompanied by flare of lesions, thus necessitating use of a second
medication such as Hydroxychloroquine , Retinoids, or Belimumab.
• Cytotoxic medications such as Methotrexate, Azathioprine, or
Mycophenolate mofetil may also be effective.
• In therapy-resistant lupus dermatitis there are reports of success with

14. m INVESTIGATIONS-
LABORATORY TESTS-
1. Test for Auto-Antibodies
2. Standard Tests-
Screening tests for complete blood count, platelet count, and
and urinalysis
may detect abnormalities that contribute to the diagnosis and
and influence
management decisions.

15. Test for Auto Antibodies