Skin-nontumor - Lupus erythematosus - Systemic lupus erythematosus (SLE)

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Other dermatoses

Lupus: systemic lupus erythematosus (SLE)

Reviewer: Mowafak Hamodat MB.CH.B, MSc., FRCPC, Eastern Health, St. Johns (Canada) (see Reviewers page)
Revised: 1 August 2011, last major update August 2011
Copyright: (c) 2002-2011, PathologyOutlines.com, Inc.

Clinical features
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● Relatively common autoimmune disease of women, due to anti-DNA antibodies
● Fatigue, fever, arthritis, erythematous, bilateral butterfly (malar) rash of the face, renal disease, lymphadenopathy, and serositis
● Associated with altered immunity, drugs, viruses, genetic predisposition, hormones and ultraviolet light
● Exacerbated by sunlight
● Discoid lupus-type lesions in 1/3

Clinical description
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● Cutaneous lesions take the form slightly indurated patches with minimal scale

Clinical images
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Malar rash of face

Micro description
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● Fibrinoid necrosis at dermoepidermal junction with liquefactive degeneration and atrophy of epidermis
● More mucin deposition in reticular dermis than discoid lupus
● Edema, small hemorrhages and a mild infiltrate of inflammatory cells, principally lymphocytes, in upper dermis
● Eosinophils in drug-induced cases and urticarial lesions
● Fibrinoid material is deposited in the dermis around capillary blood vessels, on collagen and in the interstitium
● In non-bullous cases, neutrophils are sometimes present in the upper dermis, both perivascular and interstitial with leukocytoclasis

Micro images
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Various images

Positive stains
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● IgG, IgM and C5b-C9 (by direct immunofluorescence) in clinically involved skin as an irregular band at dermoepidermal junction
● IgG and IgM in 50% of cases in normal skin
● Also antibodies for ANA, rheumatoid factor, anti-double stranded DNA, ENA

Differential diagnosis
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● Polymorphous light eruption
● Jessner’s lymphocytic infiltration of skin

End of Skin-nontumor > Other dermatoses > Lupus erythematosus - Systemic lupus erythematosus (SLE)

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