Tumid lupus erythematosus | |
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Other names | "Lupus erythematosus tumidus" [1] |
Specialty | Dermatology |
Tumid lupus erythematosus is a rare, but distinctive entity in which patients present with edematous erythematous plaques, usually on the trunk. [2]
Lupus erythematosus tumidus (LET) was reported by Henri Gougerot and Burnier R. in 1930. It is a photosensitive skin disorder, a different subtype of cutaneous lupus erythematosus (CLE) from discoid lupus erythematosus (DLE) or subacute CLE (SCLE). [3] LET is usually found on sun-exposed areas of the body. Skin lesions are edematous, urticarialike annular papules and plaques. Topical corticosteroids are not effective as treatment for LET, but many will respond to chloroquine. LET resolves with normal skin, no residual scarring, no hyperpigmentation or hypopigmentation. Cigarette smokers who have LET may not respond very well to chloroquine. [4] [5]
It has been suggested that it is equivalent to Jessner lymphocytic infiltrate of the skin. [6]
The characteristic presentation of tumid lupus erythematosus is erythematous, edematous plaques that lack ulceration or scaling. [4] In contrast to discoid lupus erythematosus (DLE), there is no atrophy, scarring, or follicular plugging. Skin exposed to the elements, such as the face, upper chest (V-neck distribution), upper back, extensor arms, and shoulders, is typically affected by tumid lupus erythematosus. [7] Rare cases of tumid lupus erythematosus affecting the lower extremities have been documented, nevertheless. [8] Tumid lupus erythematosus typically manifests itself in the summer in temperate climates. [7]
Papules and plaques of tumid lupus erythematosus can create an annular pattern in certain patients, resembling annular subacute cutaneous lupus erythematosus (SCLE), with less edema at the center. A Blaschkoid distribution, [9] [10] scalp involvement resembling alopecia areata, [11] and periorbital edema are less frequent signs of tumid lupus erythematosus. [12]
There is currently no known unique etiology for tumid lupus erythematosus. However, it has been shown that triggering variables like ultraviolet (UV) exposure can exacerbate tumid lupus erythematosus lesions. [13] Its link to autoimmune disease has generated debate; an autoimmune workup may be started if an autoimmune disease is suspected. [14] [15] It is suggested that immune dysregulation results in T cell suppression. [16] There has been evidence of a correlation between smoking and medications such as thiazide diuretics, monoclonal antibodies, angiotensin-converting enzyme inhibitors, tumor necrosis factor antagonists, and highly active antiretroviral therapy. [17] [18]
The identification of consistent clinical symptoms and histopathologic findings is the basis for the diagnosis of tumid lupus erythematosus. Provocative phototesting results and antimalarial medication response are additional tests that are not usually required but can confirm a diagnosis of tumid lupus erythematosus. [7]
Proposed diagnostic criteria reflect key findings in tumid lupus erythematosus: [4]
First-line treatments include photoprotection, topical calcineurin inhibitors, and intralesional and/or topical corticosteroids. Antimalarial medications like hydroxychloroquine or chloroquine should be used as part of a systemic treatment for patients who do not respond to conservative therapy or who have a severe illness. Methotrexate or mycophenolate mofetil along with folic acid supplements are examples of second-line therapy. [19] If all previous treatments are ineffective, third-line treatments such as thalidomide or lenalidomide may be considered. [4] [20] Another effective treatment for suppressive, non-curative conditions is pulse dye laser. [21] In order to keep the lesions from relapsing in these patients, trigger avoidance measures including wearing sunscreen and abstaining from smoking are essential. [19]
Lichen planus (LP) is a chronic inflammatory and autoimmune disease that affects the skin, nails, hair, and mucous membranes. It is not an actual lichen, but is named for its appearance. It is characterized by polygonal, flat-topped, violaceous papules and plaques with overlying, reticulated, fine white scale, commonly affecting dorsal hands, flexural wrists and forearms, trunk, anterior lower legs and oral mucosa. The hue may be gray-brown in people with darker skin. Although there is a broad clinical range of LP manifestations, the skin and oral cavity remain as the major sites of involvement. The cause is unknown, but it is thought to be the result of an autoimmune process with an unknown initial trigger. There is no cure, but many different medications and procedures have been used in efforts to control the symptoms.
Mepacrine, also called quinacrine or by the trade names Atabrine or Atebrin (german), is a medication with several uses. It is related to chloroquine and mefloquine. Although formerly available from compounding pharmacies, as of August 2020 it is unavailable in the United States.
Granuloma annulare (GA) is a common, sometimes chronic skin condition which presents as reddish bumps on the skin arranged in a circle or ring. It can initially occur at any age, though two-thirds of patients are under 30 years old, and it is seen most often in children and young adults. Females are two times as likely to have it as males.
Discoid lupus erythematosus is the most common type of chronic cutaneous lupus (CCLE), an autoimmune skin condition on the lupus erythematosus spectrum of illnesses. It presents with red, painful, inflamed and coin-shaped patches of skin with a scaly and crusty appearance, most often on the scalp, cheeks, and ears. Hair loss may occur if the lesions are on the scalp. The lesions can then develop severe scarring, and the centre areas may appear lighter in color with a rim darker than the normal skin. These lesions can last for years without treatment.
Lupus erythematosus is a collection of autoimmune diseases in which the human immune system becomes hyperactive and attacks healthy tissues. Symptoms of these diseases can affect many different body systems, including joints, skin, kidneys, blood cells, heart, and lungs. The most common and most severe form is systemic lupus erythematosus.
Complement 2 deficiency is a type of complement deficiency caused by any one of several different alterations in the structure of complement component 2.
Pemphigus erythematosus is simply a localized form of pemphigus foliaceus with features of lupus erythematosus.
Impetigo herpetiformis is a form of severe pustular psoriasis occurring in pregnancy which may occur during any trimester.
Chilblain lupus erythematosus was initially described by Hutchinson in 1888 as an uncommon manifestation of chronic cutaneous lupus erythematosus. Chilblain lupus erythematosus is characterized by a rash that primarily affects acral surfaces that are frequently exposed to cold temperatures, such as the toes, fingers, ears, and nose. The rash is defined by oedematous skin, nodules, and tender plaques with a purple discoloration.
Subacute cutaneous lupus erythematosus is a clinically distinct subset of cases of lupus erythematosus that is most often present in white women aged 15 to 40, consisting of skin lesions that are scaly and evolve as poly-cyclic annular lesions or plaques similar to those of plaque psoriasis.
Lupus erythematosus panniculitis presents with subcutaneous nodules that are commonly firm, sharply defined and nontender.
Anetoderma is a benign but uncommon disorder that causes localized areas of flaccid or herniated sac-like skin due to a focal reduction of dermal elastic tissue. Anetoderma is subclassified as primary anetoderma, secondary anetoderma, iatrogenic anetoderma of prematurity, congenital anetoderma, familial anetoderma, and drug-induced anetoderma.
Palisaded neutrophilic and granulomatous dermaititis (PNGS) is usually associated with a well-defined connective tissue disease, lupus erythematosus or rheumatoid arthritis most commonly, and often presents with eroded or ulcerated symmetrically distributed umbilicated papules or nodules on the elbows.
Neutrophilic dermatosis of the dorsal hands (NDDH) is a skin condition that presents with edematous pustular or ulcerative nodules or plaques localized to the dorsal hands.
Reticular erythematous mucinosis (REM) is a skin condition caused by fibroblasts producing abnormally large amounts of mucopolysaccharides. It is a disease that tends to affect women in the third and fourth decades of life.
Actinic granuloma (AG) was first described by O'Brien in 1975 as a rare granulomatous disease. Lesions appear on sun-exposed areas, usually on the face, neck, and scalp, with a slight preference for middle-aged women. They are typically asymptomatic, single or multiple, annular or polycyclic lesions measuring up to 6 cm in diameter, with slow centrifugal expansion, an erythematous elevated edge, and a hypopigmented, atrophic center.
Postinflammatory hypopigmentation is a cutaneous condition characterized by decreased pigment in the skin following inflammation of the skin.
Livedoid vasculopathy(LV) is an uncommon thrombotic dermal vasculopathy that is characterized by excruciating, recurrent ulcers on the lower limbs. Livedo racemosa, a painful ulceration in the distal regions of the lower extremities, is the characteristic clinical appearance. It heals to form porcelain-white, atrophic scars, also known as Atrophie blanche.
Rheumatoid neutrophilic dermatitis, also known as rheumatoid neutrophilic dermatosis, is a cutaneous condition associated with rheumatoid arthritis.
Rowell's syndrome was described by Professor Neville Rowell and colleagues in 1963. Patients with the syndrome have lupus erythematosus, annular lesions of the skin like erythema multiforme associated with a characteristic pattern of immunological abnormalities. It is uncommon but occurs worldwide.