Most common types of mucocutaneous lesions associated with SLE

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Most common types of mucocutaneous lesions associated with SLE

Pathology:

  • • Interface dermatitis is generally seen in rashes of SLE (but can also be seen indermatomyositis)
  • • Biopsy can also demonstrate immunoglobulins deposited at dermal epidermal junctionon immunofluorescence (lupus band test)

Treatment:

  • • Photo protection should be employed in all cutaneous lupus rashes
  • • Controlling generalized SLE activity can be helpful but is not always successful
  • • Hydroxychloroquine (with or without quinacrine) can be used for stubborn skin activity
  • • Chloroquine 250 mg per day can be used as an alternative to hydroxychloroquine. Dapsone should be considered for all vesicular lupus skin lesions.
  • • Consider thalidomide for severe mouth ulcerations (make sure to have birth control forpremenopausal females)
  • • Belimumab has been used for recalcitrant discoid or subacute rashes
  • • Consider methotrexate, mycophenolate mofetil, azathioprine, or rituximab as well

Less common rashes seen in SLE:

  • • bullous lesions
  • • palpable purpura due to small vessel vasculitis
  • • urticaria that may also be due to small vessel vasculitis. Test for anti-C1q antibodies.
  • • panniculitis with subcutaneous nodules (lupus profundus)
  • • livedo reticularis (seen with antiphospholipid antibodies)
  • • perniosis (distal vasculopathy)

Pearl : For severe SLE skin disease, consider a combination of hydroxychloroquine and quinacrine. The quinacrine must be made at a compounding pharmacy and paid for out of pocket. Patients sometimes develop a slight orange hue of the skin with these two therapies.

Pearl : Suspect a drug-induced cause for any patient aged >50 years who develops SCLE.

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