Distinctive cutaneous subsets in the spectrum of lupus erythematosus

Gilliam, James N.; Sontheimer, Richard D.

doi:10.1016/s0190-9622(81)80261-7

Cited by 481 publications

(327 citation statements)

References 17 publications

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“…Chronic CLE includes discoid lupus erythematosus, lupus profundus, and LE tumidus, among others. Of the nonspecific LE cutaneous lesions, Raynaud's phenomenon, bullous LE, and vasculitic lesions are most common (1)(2)(3).…”

Section: Lupus Erythematosus (Le) Is An Autoimmune Disease That Can Ementioning

confidence: 99%

Double‐blind, randomized, controlled clinical trial of clofazimine compared with chloroquine in patients with systemic lupus erythematosus

Bezerra¹,

Vilar²,

Neto³

et al. 2005

Arthritis & Rheumatism

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Objective. To evaluate the efficacy of clofazimine (CFZ) compared with chloroquine diphosphate (CDP) for the treatment of cutaneous involvement in systemic lupus erythematosus (SLE).Methods. A prospective, randomized, controlled, double-blind clinical trial was carried out in SLE patients with active cutaneous lesions, of whom 16 were randomized to receive CFZ at 100 mg/day and 17 received CDP at 250 mg/day for 6 months. All drugs had a similar appearance to avoid identification. Both groups received broad-spectrum sunscreens twice a day and the prednisone dose was kept stable during the study. Cutaneous lesions were evaluated by 2 blinded observers at baseline and at months 1, 2, 4, and 6.Results. Thirty-three patients were randomized to a treatment group, of whom 27 completed 6 months of treatment. The groups were homogeneous and comparable in terms of demographic and clinical characteristics. Five CFZ-treated patients and 1 CDP-treated patient (P ‫؍‬ 0.15) dropped out due to development of severe lupus flare. At the end of the study, 12 CFZtreated patients (75%) and 14 CDP-treated patients (82.4%) had complete or near-complete remission of skin lesions; intention-to-treat analysis showed no significant difference in the response rates between groups. Side effects, mainly skin and gastrointestinal events, were frequent in both groups, but no patients had to discontinue their treatment.Conclusion. These findings suggest that CFZ is equally as effective as CDP in controlling cutaneous lesions in SLE patients. However, we cannot exclude the possibility that the CFZ itself could be the cause of systemic lupus flare. Lupus erythematosus (LE) is an autoimmune disease that can exclusively affect the skin (cutaneous LE [CLE]) or can affect other systems as well (systemic LE [SLE]). Cutaneous lesions are classified as either specific or nonspecific. Lupus-specific cutaneous lesions are divided into acute, subacute, and chronic. Acute CLE includes malar and generalized maculopapular rashes. Subacute CLE includes the annular-polycyclic and papulosquamous (psoriasiform) variants. Chronic CLE includes discoid lupus erythematosus, lupus profundus, and LE tumidus, among others. Of the nonspecific LE cutaneous lesions, Raynaud's phenomenon, bullous LE, and vasculitic lesions are most common (1-3).In the literature, there are no reports of controlled, randomized clinical trials of a treatment strategy for SLE patients with cutaneous lesions. Based on clinical experience, antimalarial drugs are considered to be the first option for treatment of these patients (4). When a safe dosage of antimalarial drugs is used, the side effects are rare and include retinopathy, corneal deposition, disturbance of visual accommodation, nausea, vomiting, urticaria, hair discoloration, skin and mucosal hyperpigmentation, headache, tinnitus, dizziness, and myopathy, among others (5,6). Unfortunately, not all SLE patients with cutaneous lesions show a good response to antimalarial drugs. Treatment of the refractory cases includes use of thalidomide...

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Section: Lupus Erythematosus (Le) Is An Autoimmune Disease That Can Ementioning

confidence: 99%

Double‐blind, randomized, controlled clinical trial of clofazimine compared with chloroquine in patients with systemic lupus erythematosus

Bezerra¹,

Vilar²,

Neto³

et al. 2005

Arthritis & Rheumatism

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“…Four different subtypes of CLE can be distinguished: acute CLE, subacute CLE (SCLE), chronic CLE (including discoid LE, chilblain LE, and LE profundus) and intermittent LE (LE tumidus) (1,2). It is well-known since decades that several stimuli exist that might trigger or aggravate skin lesions in CLE.…”

Section: Accepted For Publication 4 June 2014mentioning

confidence: 99%

Relevant new insights into the effects of photoprotection in cutaneous lupus erythematosus

Kreuter

Lehmann

2014

Experimental Dermatology

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Commentary of 'Ultraviolet light protection by a sunscreen prevents interferon-driven skin inflammation in cutaneous lupus erythematosus'.Abstract: Cutaneous lupus erythematosus (CLE) denotes a heterogeneous spectrum of autoimmune diseases that primarily affect the skin. Ultraviolet irradiation (UV) is one of the most important environmental factors that can trigger skin lesions in CLE or even induce systemic organ manifestation. It has been shown that broad-spectrum sunscreen with high sun protection factors can effectively prevent UV-induced skin lesions in patients with different subtypes of CLE. In a recent issue of Experimental Dermatology, Zahn and colleagues demonstrate that potent photoprotection blocks disease-specific skin lesions in CLE patients by reducing lesional tissue damage and interferon-driven inflammation.Key words: cutaneous lupus erythematosus -interferon-driven inflammation -photoprotection -sunscreen -UVA/UVB irradiation Accepted for publication 4 June 2014Cutaneous lupus erythematosus (CLE) comprises a spectrum of autoimmune disorders of the skin that may present with a variety of clinical manifestations. Four different subtypes of CLE can be distinguished: acute CLE, subacute CLE (SCLE), chronic CLE (including discoid LE, chilblain LE, and LE profundus) and intermittent LE (LE tumidus) (1,2). It is well-known since decades that several stimuli exist that might trigger or aggravate skin lesions in CLE. Among those, drugs, infections, cigarette smoking and ultraviolet (UV) light play the most important role (3-5). The latter can even cause formation or deterioration of systemic organ manifestations (6). Specific CLE skin lesions can be experimentally induced by UV irradiation (7,8). Recently, a large European multicenter study has shown that approximately half of all CLE patients develop skin lesions by using a standardised UVA/UVB photoprovocation protocol. Patients with SCLE and LET had the highest percentage of UV-inducible lesions (57 and 54%, respectively), and most patients (86%) who developed UV-induced lesions were fairskinned (Fitzpatrick's phototypes I or II), and minimal erythema dose (MED) was significantly lower in photosensitive CLE patients than compared to subjects without UV-induced lesions (9).Accumulating evidence exists that CLE lesions in photosensitive patients can be prevented by the use of a highly protective broadspectrum sunscreen (10-13). A prospective, randomised, doubleblind, vehicle-controlled study evaluated the photoprotective effects of a broad-spectrum (UVA and UVB) sunscreen (sun protection factor 60) in 25 patients with a history of photosensitive CLE. After standardised phototesting for three consecutive days (60-100 J/cm² UVA and 1.5 MED UVB), 16 (64%) and 14 (56%) of the 25 patients developed specific CLE in the untreated and vehicle-treated test areas, respectively. In contrast, none of the sunscreen-treated test areas revealed any clinical or histologic signs of CLE (12). These findings were basically confirmed in a similar study including 20 patie...

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Section: Introductionmentioning

confidence: 99%

“…LE is clinically divided to three classes: systemic lupus with acute onset, sub-acute cutaneous type, and a chronic discoid form (discoid lupus erythematosus [DLE]). Occurring two to three times more often than SLE, cutaneous lupus is a variant of LE being able to bother the patients' daily life [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15].On the other side, DLE is characterized by well-defined erythematosus scaly patches mostly seen on face and other sun exposed areas; palmoplantar lesions are rarely seen in DLE and can be disabling to the patients especially when we know they are refractory to the conventional treatments [16][17][18][19]. There is a variant of DLE called tumid lupus erythematosus (TLE) which is recognized by excess production of mucin in derma giving the skin a brawny appearance with indurations.…”

mentioning

confidence: 99%

Which Skin Lupus Criteria are of More Value in Determining the Disease: A Greater View with the Help of Direct Immune Fluorescent (DIF)

Emamzadehfard¹,

Ghannadan²

2016

J Clin Med Genomics

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Background: Lupus erythematosus (LE) includes a spectrum of auto immune disorders, involving whole body (systemic LE) in one end and is cutaneous limited LE on the other side. Cutaneous LE mainly diagnosed via clinical manifestations as well as histopathologic examination. According to different pathologic specifications, the aim of present study was to determine which histopathologic criterion is more accurate and practical in diagnosing cutaneous LE. Material and Methods:The Samples which have been taken were from the patients with clinical manifestations of Cutaneous LE with pathologic confirmation. All patients had direct immuno fluorescent (DIF) samples that recorded. Histopathologic findings are categorized into three groups: group 1 contains epidermal changes, group 2 includes interface changes and group 3 contains dermal changes. Different histopathologic finding such as prevascular infiltration, follicular atrophy, follicular plaque, and basements membrane thickness and other changes, as well as DIF patterns, were recorded in designed questionnaires. Further analysis had been done with SPSS software version 22. Results:Of 145 patients (61.4% female and 38.6% male) in 58.6% DLE was the first clinical diagnosis, 23% was the second and in subsequent 4.1%, 1.4% and 0.7% was third, fourth and fifth diagnosis respectively. In 11% of caeses DLE was not among clinical impressions. DIF was positive in 49%. As a whole, superficial perivascular and perifolicular infiltration were observed in 99% of the cases and was the commonest pathologic feature followed by basal vacuolization, peri follicular infiltration and epidermal atrophy. Other pathologic changes were observed with variable rates.Discussion: By grouping histopathologic criterion, it seems that hyperkeratosis and thickening of Basement membrane may be major histologic criterion and peri vascular infiltration, peri follicular infiltration and eccrine gland infiltration, may be minor. Keywords IntroductionGenetic, hormones, and environment play altogether to give birth to lupus erythematosus (LE); a disease of autoimmune features with a more frequency in women especially in childbearing age which can present variously in different involved organs. The aforesaid disease could be manifested from a skin lesion (cutaneous lupus) to a fatal diffused type (systemic lupus erythematosus [SLE]). LE is clinically divided to three classes: systemic lupus with acute onset, sub-acute cutaneous type, and a chronic discoid form (discoid lupus erythematosus [DLE]). Occurring two to three times more often than SLE, cutaneous lupus is a variant of LE being able to bother the patients' daily life [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15].On the other side, DLE is characterized by well-defined erythematosus scaly patches mostly seen on face and other sun exposed areas; palmoplantar lesions are rarely seen in DLE and can be disabling to the patients especially when we know they are refractory to the conventional treatments [16][17][18][19]. There is a variant...

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Distinctive cutaneous subsets in the spectrum of lupus erythematosus

Cited by 481 publications

References 17 publications

Double‐blind, randomized, controlled clinical trial of clofazimine compared with chloroquine in patients with systemic lupus erythematosus

Double‐blind, randomized, controlled clinical trial of clofazimine compared with chloroquine in patients with systemic lupus erythematosus

Relevant new insights into the effects of photoprotection in cutaneous lupus erythematosus

Which Skin Lupus Criteria are of More Value in Determining the Disease: A Greater View with the Help of Direct Immune Fluorescent (DIF)

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