Neonatal lupus erythematosus: the use of telephone images in diagnosis

Abstract

We report a 7-month-old white boy with neonatal lupus erythematosus (NLE), for whom diagnosis of his resolved rash was only possible after review of images of his skin lesions stored on his mother's smartphone.The boy was born at full term by vaginal delivery to a 34-year-old primigravida, following an uncomplicated pregnancy. At 5 weeks of age, he developed multiple scaly annular plaques on his face, chest and back, which over a few months increased in size and cleared centrally. The lesions were asymptomatic and resolved spontaneously when the child was 5 months old. They were not present at the time of examination in our dermatology clinic. However, we suspected NLE after review of photographs stored on his mother's smartphone (Fig. 1). These photographs enabled the correct diagnosis to be made and monitoring of the infant for potential serious sequelae to be planned. At presentation, the child had no hepatosplenomegaly or lymphadenopathy. Full blood count, liver function tests and electrocardiogram were normal. His mother was positive for antinuclear antibodies, double-stranded DNA (22 IU/mL; normal < 10 IU/ mL), and Ro 60, and negative for La, anti-smooth muscle, Jo-1, Scl 70, Sm/RNP, centromere, and IgG and IgM anticardiolipin antibodies. She was asymptomatic without history or clinical signs of systemic lupus erythematosus (SLE).NLE is an uncommon systemic autoimmune disease. It is caused by transplacental maternal immunoglobulin G anti-Ro, anti-La and/or anti-U1-ribonucleoprotein (anti-U1-RNP) autoantibodies against fetal heart, liver, platelets and rarely brain. Only 1% of Figure 1 Erythematous annular and scaly plaques on (a,b) the face and (c) the trunk. ª 2014 British Association of Dermatologists

Photography in dermatology ‐ a scoping review: Practices, skin of color, patient preferences, and medical‐legal considerations

“…Clinical photography is especially helpful in making diagnoses or monitoring disease progression 22–24 . For example, monthly serial photography of the nail has been shown to monitor resolution of subungual hematomas, ease patient anxiety, and minimize unnecessary nail biopsy 25 .…”

“…Most authors do not disclose the setting of their photography practice, whether it is conducted in a private or public clinic 18–21,23–25,27–29,31–33 . Those who do provide such information predominantly report hospital‐based practices 22,26,34,35–38 .…”

“…21 Clinical photography is especially helpful in making diagnoses or monitoring disease progression. [22][23][24] For example, monthly serial photography of the nail has been shown to monitor resolution of subungual hematomas, ease patient anxiety, and minimize unnecessary nail biopsy. 25 Clinical photography can also help clinicians accurately diagnose transient skin conditions such as urticaria or Raynaud's phenomenon, especially when skin findings are absent at the time of seeking medical care.…”

“…5 Most authors do not disclose the setting of their photography practice, whether it is conducted in a private or public clinic. [18][19][20][21][23][24][25][27][28][29][31][32][33] Those who do provide such information predominantly report hospital-based practices. 22,26,34,[35][36][37][38] Both the equipment and frequency of photography use in private and public practices are comparable.…”

Fotografie in der Dermatologie – ein Scoping Review: Praktiken, Skin of Color, Patientenpräferenzen und medizinisch‐rechtliche Überlegungen

“…Klinische Fotografie ist insbesondere bei der Erstellung der Diagnose oder der Überwachung des Krankheitsverlaufs hilfreich 22–24 . Zum Beispiel konnten durch monatliche serielle Fotografie des Nagels die Auflösung subungualer Hämatome überwacht, die Verunsicherung der Patienten vermindert und unnötige Nagelbiopsien minimiert werden 25 .…”