Hypertrophic lupus erythematosus: a clinicopathological study of 14 cases

Daldon, Patrícia Érica Christofoletti; Souza, Elemir Macedo de; Cintra, Maria Letícia

doi:10.1034/j.1600-0560.2003.00082.x

Cited by 67 publications

(75 citation statements)

References 47 publications

(38 reference statements)

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“…11,12 A final confounder is that squamous cell carcinoma is an uncommon late complication of HLE. 8 Interestingly, a recent study suggests that CD123-positive plasmacytoid dendrocytes are abundant at the dermoepidermal junction in HLE, but they are present only as single or rare scattered clusters in squamous cell carcinoma and actinic keratoses.…”

Section: Differential Diagnosismentioning

confidence: 99%

“…Although LDE may contain eosinophils in the infiltrate and parakeratosis, eosinophils have also been reported within a subset of HLE lesions ( Figure 6). 8,11 Other disorders with prominent epidermal hyperplasia and inflammation not considered primary interface dermatitides may rarely enter the differential of HLE. The halogenodermas are a group of dermatoses caused by chronic application or ingestion of halogens.…”

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confidence: 99%

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Cutaneous Hypertrophic Lupus Erythematosus: A Challenging Histopathologic Diagnosis in the Absence of Clinical Information

Arps

Patel

2013

Archives of Pathology &Amp; Laboratory Medicine

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Hypertrophic lupus erythematosus (HLE) is rare variant of chronic cutaneous lupus characterized histologically by irregular epidermal hyperplasia associated with features of classic chronic cutaneous lupus, including interface changes. Lesions frequently demonstrate reactive squamous atypia of the basal layer and may show histopathologic overlap with other more common cutaneous atypical squamoproliferative lesions. Typical histologic features of cutaneous lupus, such as follicular plugging, angiocentric lymphocytic inflammation, and dermal mucin, are very helpful clues to the diagnosis of hypertrophic lupus erythematosus. Recently, immunohistochemistry for CD123 used to detect increased plasmacytoid dendrocytes in hypertrophic lupus erythematosus has proven to be diagnostically useful. A high index of suspicion for hypertrophic lupus erythematosus is essential to avoid overdiagnosis of squamous neoplasia, particularly in limited cutaneous biopsies in the absence of adequate clinical information.

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Section: Differential Diagnosismentioning

confidence: 99%

mentioning

confidence: 99%

Cutaneous Hypertrophic Lupus Erythematosus: A Challenging Histopathologic Diagnosis in the Absence of Clinical Information

Arps

Patel

2013

Archives of Pathology &Amp; Laboratory Medicine

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“…Cases of verrucous (papillated or digitated) hypertrophic LE were excluded because they have been previously evaluated and addressed in well-documented reports. [5][6][7] Of the 26 biopsies, there were 8 deep punch biopsies, 13 shave biopsies or curettings, and 5 incisional or excisional biopsies.…”

Section: Methodsmentioning

confidence: 99%

“…For example, hypertrophic DLE has been described as resembling keratoacanthoma and squamous cell carcinoma. [4][5][6][7] Confusion with squamous cell carcinoma may be especially troublesome, for the occurrence of indubitable squamous cell carcinoma arising in lesions of DLE is well described. [8][9][10][11][12][13][14][15][16][17] Nonhypertrophic and atrophic lesions of CLE can exhibit similar atypical changes and may also mimic squamous neoplasia.…”

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confidence: 99%

Cutaneous lupus erythematosus simulating squamous neoplasia: The clinicopathologic conundrum and histopathologic pitfalls

Zedek¹,

Smith²,

Hitchcock³

et al. 2007

Journal of the American Academy of Dermatology

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“…1 Treatments are local cryotherapy, topical corticosteroids and intralesional triamcinolone acetonide. The skin lesions are, however, often chronic and refractory to these therapies.…”

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confidence: 99%

Hypertrophic lupus erythematosus successfully treated with hydroxychloroquine

Yoshimoto

Shinkuma

Ujiie

et al. 2016

The Journal of Dermatology

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A 38-year-old woman was referred to our department with a 12-year history of a hypertrophic plaque on the right upper arm and multiple scaly erythema on the face. She had been treated with topical 0.1% tacrolimus and clobetasone propionate for several years without improvement. At the initial visit, multiple atrophic erythema and scars were observed on the right cheek and nose. Small erosions and atrophic scars were noted on the lips. A single scaly hypertrophic plaque surrounded by erythema was revealed on the right upper arm (Fig. 1a). The kidney, heart, joints and central nervous system were unaffected. Laboratory examinations found antinuclear antibody to be positive (1:160, homogenous and cytoplasmic pattern). Anti-Sm, anti-ssDNA, anti-dsDNA and anti-SS-B antibodies were within the normal ranges, and anti-SS-A antibody was slightly elevated. Complete blood count and complement levels were normal. Histopathological examination of a biopsy from the hypertrophic plaque on the right upper arm showed marked hyperkeratosis, irregular acanthosis and liquefaction degeneration. There were focal mononuclear cell infiltrates around the skin appendages of the dermis, accompanied by dermal mucin deposition (Fig. 1b,c). We made the diagnosis of chronic cutaneous lupus erythematosus (LE) with discoid and hypertrophic LE lesions on the face and the right upper arm, respectively. After confirming by fundoscopy that the patient had no retinopathy, the patient was administrated 200 mg/day (4.65 mg/kg per day) of oral hydroxychloroquine (HCQ). Within 2 months of the HCQ administration, multiple scaly erythema on the cheek disappeared, leaving pigmentation and scars, and the hypertrophic plaque on the right upper arm started to flatten. After 6 months of HCQ treatment, the hypertrophic plaque was obviously flattened, and the surrounding erythema had disappeared, leaving pigmentation (Fig. 1d). The Cutaneous Lupus Erythematosus Disease Area and Severity Index score decreased from 11 to 6 in activity and from 4 to 3 in damage.Hypertrophic LE is a rare variant of chronic cutaneous LE that is characterized by irregular epidermal hyperplasia and hyperkeratosis.1 Treatments are local cryotherapy, topical corticosteroids and intralesional triamcinolone acetonide. The skin lesions are, however, often chronic and refractory to these therapies. HCQ is an antimalarial drug that has been used as a standard treatment for LE, especially for severe and widespread cutaneous LE and refractory cutaneous LE. 2,3 In Japan, however, HCQ was not approved until recently, because of the side-effects of a similar drug (chloroquine), most notably retinopathy. It is well known that severe retinopathy from HCQ can be avoided by using the appropriate dose in conjunction with regular retinal examinations. The high-magnification image shows liquefaction degeneration of the epidermal basal membrane zone and mononuclear cell infiltration (HE, 9200). (d) Clinical manifestations after 10 months of treatment with HCQ. The hypertrophic lesion has markedly flattene...

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Hypertrophic lupus erythematosus: a clinicopathological study of 14 cases

Cited by 67 publications

References 47 publications

Cutaneous Hypertrophic Lupus Erythematosus: A Challenging Histopathologic Diagnosis in the Absence of Clinical Information

Cutaneous Hypertrophic Lupus Erythematosus: A Challenging Histopathologic Diagnosis in the Absence of Clinical Information

Cutaneous lupus erythematosus simulating squamous neoplasia: The clinicopathologic conundrum and histopathologic pitfalls

Hypertrophic lupus erythematosus successfully treated with hydroxychloroquine

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