Tumid lupus erythematosus
| Tumid lupus erythematosus | |
|---|---|
| Other names | "Lupus erythematosus tumidus"[1] |
| Specialty | Dermatology |
Tumid lupus erythematosusis a rare, but distinctive entity in which patients present with edematous erythematous plaque.[2]
Lupus erythematosus tumidus (LET) was reported byHenri Gougerotand Burnier R. in 1930. It is a photosensitive skin disorder, a different subtype ofcutaneous lupus erythematosus(CLE) fromdiscoid lupus erythematosus(DLE) or subacute CLE (SCLE).[3]LET is usually found on sun-exposed areas of the body. Skin lesions are edematous, urticarialike annularpapulesand plaques.Topical corticosteroidsare not effective as treatment for LET, but many will respond tochloroquine.LET resolves with normal skin, no residual scarring, nohyperpigmentationorhypopigmentation.Cigarette smokers who have LET may not respond very well tochloroquine.[4][5]
It has been suggested that it is equivalent toJessner lymphocytic infiltrate of the skin.[6]
Signs and symptoms
[edit]The characteristic presentation of tumid lupus erythematosus iserythematous,edematous plaques that lack ulceration or scaling.[4]In contrast todiscoid lupus erythematosus(DLE), there is noatrophy,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]
Papulesand plaques of tumid lupus erythematosus can create an annular pattern in certain patients, resembling annularsubacute cutaneous lupus erythematosus(SCLE), with lessedemaat the center. A Blaschkoid distribution,[9][10]scalp involvement resemblingalopecia areata,[11]andperiorbital edemaare less frequent signs of tumid lupus erythematosus.[12]
Causes
[edit]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 toautoimmune diseasehas generated debate; an autoimmune workup may be started if anautoimmune diseaseis suspected.[14][15]It is suggested that immune dysregulation results inT cellsuppression.[16]There has been evidence of a correlation between smoking and medications such asthiazide diuretics,monoclonal antibodies,angiotensin-converting enzyme inhibitors,tumor necrosis factorantagonists, andhighly active antiretroviral therapy.[17][18]
Diagnosis
[edit]The identification of consistent clinical symptoms and histopathologic findings is the basis for the diagnosis of tumid lupus erythematosus. Provocative phototesting results andantimalarial medicationresponse 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]
- Clinical- Smooth-surfaced, succulent, urticarial-like, erythematous plaques in sun-exposed areas.[4]
- Histologic- There is no epidermal involvement or modification of the dermoepidermal interface; instead, there is perivascular and periadnexal lymphocytic infiltration, interstitialmucindeposition, and, in certain instances, dispersedneutrophils.[4]
- Phototesting- Skin lesion proliferation following exposure to ultraviolet A (UVA) and/or ultraviolet B (UVB) radiation.[4]
- Treatment- Quick and efficient systemicantimalarial medicationtreatment.[4]
Treatment
[edit]First-line treatments include photoprotection, topicalcalcineurin inhibitors,and intralesional and/ortopical corticosteroids.Antimalarial medicationslikehydroxychloroquineorchloroquineshould be used as part of a systemic treatment for patients who do not respond to conservative therapy or who have a severe illness.Methotrexateormycophenolate mofetilalong withfolic acidsupplements are examples of second-line therapy.[19]If all previous treatments are ineffective, third-line treatments such asthalidomideorlenalidomidemay be considered.[4][20]Another effective treatment for suppressive, non-curative conditions ispulse 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]
See also
[edit]References
[edit]- ^Rapini, Ronald P.; Bolognia, Jean L.; Jorizzo, Joseph L. (2007).Dermatology: 2-Volume Set.St. Louis: Mosby.ISBN978-1-4160-2999-1.
- ^James, William; Berger, Timothy; Elston, Dirk (2005).Andrews' Diseases of the Skin: Clinical Dermatology.(10th ed.). Saunders. Page 159.ISBN0-7216-2921-0.
- ^Gougerot H, Burnier R. Lupus érythémateux "tumidus". Bull Soc Fr Dermatol Syphiligr. 1930;37:1291-1292.
- ^abcdefghKuhn, Annegret; Richter-Hintz, Dagmar; Oslislo, Claudia; Ruzicka, Thomas; Megahed, Mosaad; Lehmann, Percy (2000-08-01). "Lupus Erythematosus Tumidus".Archives of Dermatology.136(8). American Medical Association (AMA): 1033–1041.doi:10.1001/archderm.136.8.1033.ISSN0003-987X.PMID10926740.
- ^Callen, Jeffrey P. (2002). "Management of skin disease in patients with lupus erythematosus".Best Practice & Research Clinical Rheumatology.16(2). Elsevier BV: 245–264.doi:10.1053/berh.2001.0224.ISSN1521-6942.PMID12041952.
- ^"Jessner Lymphocytic Infiltration of the Skin: eMedicine Dermatology".Retrieved2010-05-22.
- ^abc"UpToDate".UpToDate.Retrieved2024-03-02.
- ^Stead, Jennifer; Headley, Catherine; Ioffreda, Michael; Kovarik, Carrie; Werth, Victoria (2008)."Coexistence of Tumid Lupus Erythematosus With Systemic Lupus Erythematosus and Discoid Lupus Erythematosus".JCR: Journal of Clinical Rheumatology.14(6). Ovid Technologies (Wolters Kluwer Health): 338–341.doi:10.1097/rhu.0b013e31817d1183.ISSN1076-1608.PMC2829660.PMID18664992.
- ^Pacheco, T R; Spates, S T; Lee, L A (2002). "Unilateral tumid lupus erythematosus".Lupus.11(6). SAGE Publications: 388–391.doi:10.1191/0961203302lu208cr.ISSN0961-2033.PMID12139378.S2CID35133682.
- ^Hinz, Torsten; Hornung, Thorsten; Wenzel, Joerg; Bieber, Thomas (2012-03-27). "Lupus tumidus following the lines of Blaschko".International Journal of Dermatology.52(12). Wiley: 1615–1617.doi:10.1111/j.1365-4632.2011.05419.x.ISSN0011-9059.PMID22458246.S2CID27225913.
- ^Werth, Victoria P. (1992-03-01). "Incidence of Alopecia Areata in Lupus Erythematosus".Archives of Dermatology.128(3): 368.doi:10.1001/archderm.1992.01680130082010.ISSN0003-987X.PMID1550369.
- ^Vassallo, Camilla; Colombo, Giovanni; Canevari, Frank Rikki; Brazzelli, Valeria; Ardigò, Marco; Carrera, Carlo; Cananzi, Raffaello; Borroni, Giovanni (2005-04-14). "Monolateral severe eyelid erythema and edema as unique manifestation of lupus tumidus".International Journal of Dermatology.44(10). Wiley: 858–860.doi:10.1111/j.1365-4632.2005.02210.x.ISSN0011-9059.PMID16207190.S2CID45610534.
- ^Saleh, Dahlia; Grubbs, Hailey; Koritala, Thoyaja; Crane, Jonathan S. (2023-06-28)."Tumid Lupus Erythematosus".StatPearls Publishing.PMID29494121.Retrieved2024-03-02.
- ^Jefferson, Gina D.; Aakalu, Vinay K.; Braniecki, Marylee (2017)."Tumid lupus: An unexpected diagnosis for the otolaryngologist".American Journal of Otolaryngology.38(2). Elsevier BV: 257–259.doi:10.1016/j.amjoto.2017.01.003.ISSN0196-0709.PMC5826658.PMID28122678.
- ^Fogagnolo, L.; Soares, T. C. B.; Senna, C. G.; Souza, E. M.; Blotta, M. H. S. L.; Cintra, M. L. (2014-09-12). "Cytotoxic granules in distinct subsets of cutaneous lupus erythematosus".Clinical and Experimental Dermatology.39(7). Oxford University Press (OUP): 835–839.doi:10.1111/ced.12428.ISSN0307-6938.PMID25214407.S2CID21127920.
- ^Gambichler, T.; Pätzholz, J.; Schmitz, L.; Lahner, N.; Kreuter, A. (2015-03-25). "<scp>FOXP</scp>3+ and <scp>CD</scp>39+ regulatory T cells in subtypes of cutaneous lupus erythematosus".Journal of the European Academy of Dermatology and Venereology.29(10). Wiley: 1972–1977.doi:10.1111/jdv.13123.ISSN0926-9959.PMID25808110.S2CID30625226.
- ^Böckle, B C; Sepp, N T (2014-11-19). "Smoking is highly associated with discoid lupus erythematosus and lupus erythematosus tumidus: analysis of 405 patients".Lupus.24(7). SAGE Publications: 669–674.doi:10.1177/0961203314559630.ISSN0961-2033.PMID25411260.S2CID43483915.
- ^Schneider, Stefan W.; Staender, Sonja; Schlüter, Bernhard; Luger, Thomas A.; Bonsmann, Gisela (2006-01-01). "Infliximab-Induced Lupus Erythematosus Tumidus in a Patient With Rheumatoid Arthritis".Archives of Dermatology.142(1). American Medical Association (AMA): 115–116.doi:10.1001/archderm.142.1.115.ISSN0003-987X.PMID16415403.
- ^abLiu, Evan; Daze, Robert P; Moon, Summer (2020-05-26)."Tumid Lupus Erythematosus: A Rare and Distinctive Variant of Cutaneous Lupus Erythematosus Masquerading as Urticarial Vasculitis".Cureus.Springer Science and Business Media LLC.doi:10.7759/cureus.8305.ISSN2168-8184.PMC7320659.PMID32607289.
- ^Gallitano, Stephanie M.; Haskin, Alessandra (2016)."Lupus erythematosus tumidus: A case and discussion of a rare entity in black patients".JAAD Case Reports.2(6). Elsevier BV: 488–490.doi:10.1016/j.jdcr.2016.05.022.ISSN2352-5126.PMC5149049.PMID27981226.
- ^Truchuelo, M.T.; Boixeda, P.; Alcántara, J.; Moreno, C.; de las Heras, E.; Olasolo, P.J. (2012). "Pulsed dye laser as an excellent choice of treatment for lupus tumidus: a prospective study".Journal of the European Academy of Dermatology and Venereology.26(10): 1272–1279.doi:10.1111/j.1468-3083.2011.04281.x.ISSN0926-9959.PMID21957901.
Further reading
[edit]- Schmitt, V.; Meuth, A.M.; Amler, S.; Kuehn, E.; Haust, M.; Messer, G.; Bekou, V.; Sauerland, C.; Metze, D.; Köpcke, W.; Bonsmann, G.; Kuhn, A. (2009-07-07). "Lupus erythematosus tumidus is a separate subtype of cutaneous lupus erythematosus".British Journal of Dermatology.162(1). Oxford University Press (OUP): 64–73.doi:10.1111/j.1365-2133.2009.09401.x.ISSN0007-0963.PMID19712116.S2CID23655462.
- Vieira, Vanessa; Del Pozo, Jesús; Yebra-Pimentel, Maria Teresa; Martínez, Walter; Fonseca, Eduardo (2005-01-06). "Lupus erythematosus tumidus: a series of 26 cases".International Journal of Dermatology.45(5). Wiley: 512–517.doi:10.1111/j.1365-4632.2004.02574.x.ISSN0011-9059.PMID16700782.S2CID43363996.