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Lupus Erythematosus

Lupus Erythematosus. Dr. Mohamed nasr. Types of Lupus:. Cutaneous (skin) lupus primarily affects the skin but may involve the hair and mucous membranes also commonly called discoid lupus Systemic lupus erythematosus (SLE) affects any system in the body

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Lupus Erythematosus

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  1. Lupus Erythematosus Dr. Mohamed nasr

  2. Types of Lupus: • Cutaneous (skin) lupus • primarily affects the skin but may involve the hair and mucous membranes • also commonly called discoid lupus • Systemiclupus erythematosus (SLE) • affects any system in the body • Drug-induced lupus erythematosus (DILE) • Side effect of long term use of certain medications • Symptoms overlap with those of SLE • Neonatal lupus • very rare • acquired from the passage of maternal autoantibodies

  3. Cutaneous Lupus • ACUTE: Typical photosensitive malar rash when acute • Highly associated with systemic LE (almost 100%) • SUBACUTE: This variant is psoriasiform or annular • ~50% of these patients will meet criueria for SLE • CHRONIC: ie Discoid Lupus • Most patients (85-90% never develop systemic lupus)

  4. Systemic Lupus Erythematosus • Chronic autoimmune disease • Most common form of lupus • Autoantibodies • produced by own immune system • recognize own DNA as foreign • Lupus “wolf”

  5. Understanding the causes: • Unknown • Possible Factors: • genetics • environmental • hormonal • May explain why lupus occurs more frequently in females than in males • NOT infectious

  6. Screening and Diagnosis: • Difficult • Usually takes months to even years • Laboratory tests: • Antinuclear antibody (ANA) test that detects the presence of autoantibodies that attack your own cells • blood tests for anemia, low white-cell count, abnormalities in organ function • urinalysis • electrocardiogram or echocardiogram to check the heart • chest x-ray

  7. Eleven Criteria Used for the Diagnosis of Lupus: • Malar Rash • Rash over cheeks • Discoid Rash • Red raised patches • Photosensitivity • Reaction to sunlight • Oral Ulcers • Ulcers in nose or mouth • Arthritis • Two or more joints • Serositis • Pleuritis or pericarditis

  8. Eleven Criteria cont… • Renal Disorder • Excessive protein in the urine or cast. • Neurologic Disorder • Seizures • Hematologic Disorder • Hemolytic anemia or leukopenia • Immunologic Disorder • Positive anti-double stranded anti-DNA test • Antinuclear Antibody • Positive test

  9. Why organs are attacked: • Due to autoantibodies • Also referred to as anti-nuclear antibodies • Antibodies produced by the immune system • Attack the RNA and DNA in the nucleus of own cells

  10. Systems Affected Musculoskeletal system -- avascular necrosis -- muscle inflammation Kidney system Nervous system -- seizures -- nerve paralysis -- severe depression -- psychosis -- strokes Blood and Lymph system -- anemia -- thrombocytopenia -- leucopenia

  11. Systems Affected Stomach, Intestines, Liver, and Associated Organs -- ulcers -- abdominal pains Skin and Hair -- rash and alopecia Heart and Blood Vessels -- pericarditis -- arthrosclerosis -- spasms of the artery Lungs -- pleurisy, pneumonia, and pleural effusion Eyes -- rarely involved except for retina

  12. The simplest of treatments include: 1- Anti-inflammatory drugs like Aspirin. 2- Anti- malarial drugs. 3- Immunosuppressive medications. 4- Corticosteroids.

  13. Subacute Cutaneous Lupus Erythematosus • Widespread, non-scarring but often photosensitive rash. • Annular or papulosquamous morphology. • Mild systemic disease common but renal involvement rare. • Positive ANA in most patients, but anti-nDNA uncommon. • Anti-Ro in two thirds patients.

  14. Subacute Cutaneous Lupus

  15. Discoid Lupus Erythematous (DLE) • Most scarring and chronic form of cutaneous lupus. • Discoid shaped plaques with white scale, with time, lesions become atrophic. • Can lead to scarring alopecia. • Few patients meet criteria for SLE (6%).

  16. The characteristics of DLE lesions: • Persistent localized erythema. • Adherent scales related to the dilated follicles. • Follicular plugging. • Redness & telangiectasia of the border. • Atrophy & scarring of the center.

  17. Follicular Plugging

  18. Diagnosis = lupus band test • Presence of IgG & C in linear pattern at dermo-epidermal junction below lamina densa in involved sun-exposed skin only.

  19. Treatment: • Treat with intralesional or topical steroids, sun avoidance & antimalarial if severe or large areas involved.

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