Subacute cutaneous lupus erythematosus and discoid lupus erythematosus. Comparative histopathologic findings

Abstract

Subacute cutaneous lupus erythematosus (SCLE) is a recently described distinct subset of lupus erythematosus (LE) having characteristic clinical, serologic, and genetic findings. This study describes the histopathologic characteristics of SCLE and determines whether it could be differentiated from discoid lupus erythematosus (DLE) on histopathologic grounds alone. Biopsy specimens from 33 patients having either SCLE or DLE, as defined by strict clinical criteria, were examined without knowledge of the clinical diagnosis. Histologic discrimination between SCLE and DLE was accomplished in 82%. The specimens from DLE lesions had substantially more hyperkeratosis, basement membrane thickening, follicular plugging, and superficial and deep inflammatory cell infiltrate, while SCLE had more epidermal atrophy. The histopathologic differences between SCLE and DLE further support the concept that SCLE is distinct from DLE and should be considered a unique subset of LE.

Lupus Erythematosus Tumidus

“…45,46 Histological evaluation of skin lesions is necessary to confirm the diagnosis of LET, and, therefore, it represents one of the major criteria of this disease (Table 3). In contrast to SCLE and DLE, 30,32,33,47 follicular hyperkeratosis, epidermal atrophy, vacuolar degeneration, and thickening of the basement membrane zone usually are not found. The perivascular and periadnexal infiltrate is composed of lymphocytes and, in some cases, scattered neutrophils are seen.…”

Lupus erythematosus tumidus in Childhood

“…In contrast to LET, the clinical hallmark of DLE is a discoid plaque with scarring, atrophy, and follicular plugging. In patients with SCLE, erythematous papulosquamous or annular skin lesions in sun-exposed areas can also be seen, but results of histologic examination differ from LET, demonstrating a focally thinned epidermis with vacuolar degeneration at the dermoepidermal junction [28, 29]. Furthermore, early lesions of polymorphous light eruption may be difficult to differentiate from LET; however, in contrast to LET, they occur several hours after UV irradiation, and, in most cases, polymorphous light eruption shows no improvement with antimalarial drug therapy [18, 30, 31].…”

Lúpus eritematoso cutâneo: aspectos clínicos e laboratoriais

“…Bangert et al, 17 stated that the presence of hyperkeratosis, thickening of the basal membrane, extensive follicular damage and dense lymphocyte infiltrate involving the deep dermis are findings that favor a diagnosis of DLE. The changes found in SCLE are quantitatively different from those found in DLE, and epidermal atrophy is an important characteristic.…”