Skin nontumor
Lichenoid and interface reaction patterns
Chronic cutaneous lupus
Topic Completed: 1 August 2011
Minor changes: 11 January 2021
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PubMed Search: Lupus: systemic lupus erythematosus [title] skin
Table of Contents
Clinical features | Clinical images | Microscopic (histologic) description | Positive stains | Differential diagnosisCite this page: Hamodat M. Chronic cutaneous lupus. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/skinnontumorlupussle.html. Accessed January 22nd, 2021.
Clinical features
- 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 33%
- Cutaneous lesions take the form slightly indurated patches with minimal scale
Clinical images
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Malar rash of face
Microscopic (histologic) description
- 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 nonbullous cases, neutrophils are sometimes present in the upper dermis, both perivascular and interstitial with leukocytoclasis
Positive stains
- 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
- Polymorphous light eruption
- Jessners lymphocytic infiltration of skin
