j

http://www.mtio.com/lupus/lfaskin1.htm
Lupus Skin Involvement

Acute Lupus Erythematosus
Discoid Lupus Erythematosus
Subacute Cutaneous Lupus

Lupus Skin

There are 3 categories of skin involvement in lupus: Acute cutaneous
lupus erythematosus (ACLE), Sub-acute cutaneous lupus erythematosus
(SCLE) and Chronic cutaneous lupus erythematosus (also known as Discoid
lupus).


Acute Cutaneous Lupus
Below are some pictures of the famous *Butterfly rash* (malar rash).
This rash is seen in 40 - 60% of the patients with lupus.

Acute cutaneous lupus is a photosensitve dermatitis

ACLE is usually found on the cheeks and bridge of the nose, but is also
quite often : anywhere on the face and in the *V* area of the neck.
People with ACLE usually have systemic complaints. ACLE appears to
correlate with disease activity in individuals that have the malar rash.
Treatment of ACLE is treatment of the underlying systemic disease.
Topical medication appear to do little.
The ACLE rash can last anywhere from a few days to months. After sun
exposure, the rash may appear or intesify quite suddenly. Although not
usually scarring, occasionally ACLE lesions will leave areas of hyper-
or hypo-pigmentation.

ACLE rashes can occur along with SCLE rashes, but seldom with DLE
lesions.


Discoid Lupus
Discoid lupus (DLE) is also known as Chronic cutaneous lupus. Some quick
DLE facts:
15 to 30% of the SLE patients have DLE lesions.

5 - 10% of SLE patients will have DLE as their presenting complaint.
DLE occurs most commonly between the ages of 20 and 40.
The female to male ratio is about 3:2, as opposed to SLE where the ratio
is 9:1.
The DLE lesion is usually raised or flat, red, with well-defined
borders.
DLE is often scarring, and in larger lesions (smaller lesions grow
together to make these) can be very disfiguring.
Sun-exposed areas are most often affected: the face, the ears, the
scalp, the V of the neck, and the top-side of the forearm.
The most common treatments of DLE are: antimalarials, topical injections
, sun-protection, and in more progressive, severe cases, intense courses
of corticosteroids


Subacute Cutaneous Lupus
SCLE is sometimes described as a disease midway between SLE and DLE.
SCLE quick facts:
SCLE appears to affect primarily white females.
A majority of the people affected by SCLE (85%) are extremely
photosensitive

SCLE is a subset of SLE. Approximately 70% of people affected by SCLE
have a positve test for anti-Ro (SSA).
SCLE can coexist with SLE and DLE.
Cutaneous vasculitis is a common occurrance with SCLE.
60 to 81% of patients with SCLE have positive ANAs, but only about 50%
of the positive ANAs are of a significant titer.

SCLE is treated in the same way both SLE and DLE are treated. Depending
on the symptom--antimalarials, steroids, cytotoxic drugs, sunprotection,
cortisone creams--are all of use.
Although usually a disease of benign nature, some SCLE patients develop
severe life-threatening disease.