We report a case of a patient with localized discoid lupus erythematosus dle who was found to have highgrade squamous dysplasia carcinoma in. Since the first description of discoid lupus erythematosus le in two dogs in 1979, the spectrum of canine cutaneous lupus erythematosus cle variants has expanded markedly. Discoid lupus erythematosus dle is the most common chronic form of cutaneous lupus. Chronic cutaneous lupus erythematosus discoid lupus erythematosus dle.
Tumid lupus erythematosus tle is a subtype of discoid lupus erythematosus dle whose clinical characteristics rarely have been described in the literature. C utaneous lupus erythematosus lupus in the skin includes discoid lupus and several other types of skin lupus. Scarring alopecia is a very frequent feature of chronic discoid lupus erythematosus dle. Discoid lupus erythematosus histology dle lesions demonstrate interface changes at the dermalepidermal junction and the basement membrane zone region of follicular epithelium. Discoid lesions are the most common skin manifestations of ccle. The center areas may appear lighter in color surrounded by an area darker than the normal skin. Prior to biopsy, assess response to 3 weeks of antibiotics. Dermoscopy revealed cicatricial alopecia, with the presence of keratin plugs at the periphery of the plates, and brown and white areas without structure, irregular linear vessels as well as telangiectasias, figure2. To describe the clinical, histopathologic, and other laboratory findings in tumid lupus erythematosus. Original article discoid lupus erythematosus in a saudi population. It is classified as either localised, affecting skin above the neck only, or generalised, affecting above and below the neck. It presents with red, inflamed, coinshaped patches of skin with a scaling and crusty appearance, most often on the scalp, cheeks, and ears. Serologic markers mirroring disease activity in discoid lupus erythematosus dle patients are unknown. A number of candidate genes have been identified which increase the risk.
Recent advances in our understanding of the pathophysiological basis of le bring. Pdf cutaneous lupus erythematosus issues in diagnosis and. Discoid lupus erythematosus with squamous cell carcinoma. Discoid lupus erythematosus at the vermilion border of the. It typically causes a loss of color in the hairless, moist part of the nose. Discoid lupus erythematosus is an uncommon skin rash, usually made worse by exposure to sunlight. Imiquimodinduced subacute cutaneous lupus erythematosus. Lupus profundus is a rare manifestation of cutaneous lupus erythematosus, seen in 1% to 3% of patients. A lymphocytic interface dermatitis is seen, associated with vacuolar degeneration of basal layer keratinocytes of the hair follicle and of the interfollicular epidermis with pronounced keratotic follicular plugging. They develop as an inflamed growth with scaling and a warty like appearance. Discoid lupus erythematosus is the most common type of chronic cutaneous lupus ccle, an autoimmune skin condition on the lupus erythematosus spectrum of illnesses. Early recognition and treatment improves the prognosis. Although subacute cutaneous lupus erythematosus scle has been reported in association with multiple systemic medications, scle in patients treated with topical agents. It is characterised by persistent scaly, disklike plaques on scalp, face and ears that may cause pigmentary changes, scarring and hair loss.
Recent data have provided enhanced understanding of these interactions and the mechanism by which they cause disease. Ccle encompasses discoid lupus erythematosus dle, lupus erythematosus tumidus le tumidus, lupus profundus also known as lupus panniculitis, chilblain lupus erythematosus chilblain le, and lichenoid cutaneous lupus erythematosuslichen planus overlap syndrome lelp overlap syndrome. Cutaneous lupus can be part of systemic lupus or it can be a condition on its own. Autoantibodies and disease activity in discoid lupus erythematosus patients andrew kim, md, 1, jack obrien, bs, 1, linchiang tseng, bs, 1 song zhang, phd, 2 and benjamin f. Systemic lupus erythematosus mycosis fungoides bullous pemphigoid cutaneous lupus erythematosus discoid. Pdf discoid lupus erythematosus in a saudi population. Discoid lupus erythematosus british association of. The term subacute cutaneous lupus erythematosus was coined in 1977 by gilliam. Histopathology and immunofluorescence of discoid lupus.
It has a prolonged course and can have a considerable effect on quality of life. Winkelmann rk 1981 the histopathology of lupus erythematosus. Deeptara pathak thapa, assistant professor, department of. Discoid cutaneous lupus erythematosus vca animal hospital. Received for publication july 17, 1939 diagnosis of lupus erythematosus in the present state of knowledge of the disease must depend chiefly on recognition of the cutaneous lesions 33, 40. The term discoid refers to a rash of distinct reddened patches covered with grayish brown scales that may appear on the face, neck, and scalp. Discoid lupus erythematosus dle is the most common form of cutaneous lupus erythematosus. Lupus erythematosus is a chronic inflammatory autoimmune disease with a wide range of clinical manifestations ranging from an indolent chronic cutaneous form to a severe potentially lifethreatening disease, systemic lupus erythematosus discoid lupus erythematosus is a subphenotype of chronic cutaneous lupus erythematosus, characterised by scaly diskshaped. Pathology of discoid lupus erythematosus dr sampurna roy md. Maryland lupus erythematosus le is a disease with a spectrum of disease. Lupus erythematosus le is a chronic inflammatory disease that can be clinically. Article information, pdf download for pathology, immunopathology, and.
Pdf the direct immunofluorescence dif of skin in conjunction with histopathology gives the best diagnostic yield. Discoid lupus erythematosus is a chronic skin condition characterized by inflammation and scarring type skin lesions which occur on the face, ears, scalp and at times on other body areas. Discoid lupus erythematosus at the vermilion border of the lip. Risk of systemic lupus erythematosus is approximately 5%. More mucin deposition in reticular dermis than discoid lupus. Necrotic keratinocytes and lymphocytic inflammation are present in. Discoid lupus erythematosus dle, also known as cutaneous lupus erythematosus, is an autoimmune disease that affects the skin, in which the bodys own immune system is activated to attack the body. All cases of scarring discoid lupus erythematosus le 2020 and systemic le 55 showed prominent granular c3d along the dermoepidermal junction dej and a. Discoid lupus erythematosus chronic lesions skin site. Dogs with dle develop crusting and scabbing of the skin, most commonly starting around the nose, as well as a loss of skin pigmentation in the affected area.
Department of pathology, pakistan institute of medical sciences. Dle lesions demonstrate interface changes at the dermalepidermal junction and the basement membrane zone region of follicular epithelium. It gets its name from the coinshaped lesions it produces. So far in the literature, only clinicpathologic features or histopathologicimmunopathologic traits of dle scarring alopecia dlesa have been reported. Lupus erythematosus le is a group of diverse, persistent inflammatory autoimmune diseases and often affects the skin. Histologic findings in cutaneous lupus erythematosus springerlink. Fibrinoid necrosis at dermoepidermal junction with liquefactive degeneration and atrophy of epidermis. This is usually easily done in typical cases of the chronic localized discoid type of the. Backgroundpurpose discoid lupus erythematosus dle, the most common chronic cutaneous form seen in le, includes inflammation leading to scarring, telangiectasias, atrophy, andor dyspigmentation. This study describes the histopathologic characteristics of scle and determines whether it could be differentiated from. Lupus erythematosus, an autoimmune disorder that causes chronic inflammation in various parts of the body. Up features in 27 cases, pediatric dermatology on deepdyve, the largest online rental service for scholarly research with thousands of academic publications available.
Discoid lupus erythematosus dle is a chronic disease which affects the dermatome which causes scarring, hair loss, and hyperpigmentation changes in the skin. Hood af, farmer er histopathology of cutaneous lupus erythematosus. The lesions are typically chronic scaly plaques on the face, scalp and ears. Dle discoid lupus collie nose what is discoid lupus.
Three main types of lupus are recognizeddiscoid, druginduced, and systemic. Johns hopkins university school of medicine, ba,ltimore. Early diagnosis and treatment of discoid lupus erythematosus. Subacute cutaneous lupus erythematosus and discoid lupus. Alrashid, mona halwani, eman almekhadab, mona alkelabi. Chong, md 1 1 department of dermatology, university of texas southwestern medical center, dallas, tx. The primary cle subsets are discoid lupus erythematosus dle, subacute cutaneous lupus erythematosus scle, and acute cutaneous lupus erythematosus acle.
The cutaneous pathology of lupus erythematosus wiley online. Molecular, cellular and histopathologic assessment of. In a study of 25 oral biopsy specimens of lesions of chronic discoid lupus erythematosus, a characteristic and diagnostic histopathological pattern was confirmed, which consisted of parakeratosis, hydropic degeneration of stratum germinativum, collagen degeneration, and a lymphocytic infiltration. Pdf immunofluorescence profile of discoid lupus erythematosus. It most commonly presents in association with classic chronic cutaneous lesions of discoid lupus erythematosus.
Histopathology kidney systemic lupus erythematosus youtube. Identifying them would help predict disease course, guide treatments, and clarify dles etiology. Lupus erythematosus le is an autoimmune connective tissue disease whose precise aetiological basis is at present uncertain, in which the clinical presentations range from a skin rash unaccompanied by extracutaneous stigmata to one comprising progressive multisystem disease. Cutaneous lesions take the form slightly indurated patches with minimal scale. Background we report the clinical and histopathological features of discoid lupus erythematosus dle in a group of saudi patients, and provide a basic framework for a subsequent larger. While the skin manifestations of lupus erythematosus le have been described for many years, the pathophysiology of cle remains to be fully characterized. Neil crowson1 and unaccompanied by extracutaneous stigmata to a rapidly progressive cynthia magro2 lethal multiorgan disease. Re cent advances in our understanding of the cutaneous histopathology which correlates with. The pathophysiology of cutaneous lupus erythematosus cle encompasses the complex interactions between genetics, the environment, and cells and their products. Apoptosis in chronic cutaneous lupus erythematosus, discoid lupus. Cutaneous histopathology of lupus erythematosus request pdf.
Other articles where discoid lupus erythematosus is discussed. Dle generally represents the benign pole of the le spectrum. Histopathology kidney systemic lupus erythematosus. Subacute cutaneous lupus erythematosus scle is a recently described distinct subset of lupus erythematosus le having characteristic clinical, serologic, and genetic findings. The clinical presentations range from a skin rash unaccompanied by extracutaneous. Pathology, immunopathology, and immunohistochemistry in.
The term lupus erythematosus is applied to a range of related disorders. Discoid lupus erythematosus dle is a skin condition of dogs. Autoantibodies and disease activity in discoid lupus. Discoid lupus affects only the skin and does not usually involve internal organs. Imiquimod is a topical immunomodulator used to treat genital warts and cutaneous malignancies that exerts its effects via induction of proinflammatory cytokines through activation of tolllike receptor tlr 7. Histology of discoid lupus erythematosus in dle, sections reveal the dermis contains a perivascular and periadnexal lymphohistiocytic infiltrate under an interface dermatitis figure 1. Discoid lupus erythematosus is a chronic dermatological disease that can lead to scarring, hair loss, and hyperpigmentation changes in skin if it is not treated early and promptly. Often, the rashes associated with lupus occur on areas of the skin exposed to sunlight or. The histopathology and immunofluorescence of discoid lupus erythematosus dle are well documented in adults, but in children they have not been studied systematically. Discoid lupus discoid lupus erythematosus is a chronic autoimmune disease affecting the skin. The epidermal interface activity shows degeneration of the basal layer, apoptotic keratinocytes and a marked thickening of the basement membrane figures 2, 3. Recent advances in our understanding of the pathophysiological basis of le bring hope for novel therapeutic approaches. Histopathology is not reliable in differentiating dle from mucocutaneous pyoderma. Cutaneous lupus erythematosus is categorized as acute, subacute, and chronic.
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