Subacute cutaneous lupus erythematosus presenting as erythroderma

Erythrodema secondary to subacute cutaneous lupus erythematosus (SCLE) is rare. We report a 61-year-old man presenting with erythroderma secondary to SCLE. During erythrodermic phase our patient still had few annular and polycyclic lesions characteristic of SCLE. He was successfully treated with topical and oral corticosteriods.     

Subacute cutaneous lupus erythematosus presenting in twins

Subacute cutaneous lupus erythematosus is a clinically distinct form of cutaneous lupus erythematosus, with age of onset typically in the second to fifth decades. Eleven cases have been reported in childhood, and we present the first known case of subacute cutaneous lupus erythematosus in identical twins. Although flares are typically photo‐induced, we present an annular eruption typical of subacute cutaneous lupus erythematosus with concurrent pinworm infestation, with recurrence of disease with cutaneous larva migrans. The patient's identical twin had a similar eruption with pinworm infection. This case highlights the possibility of parasitic infestation as a trigger for subacute cutaneous lupus erythematosus in genetically susceptible individuals.     

Subacute cutaneous lupus erythematosus presenting in a child

A 5-year-old girl presented in summer with an erythematous, scaly annular eruption in a malar distribution. She had no symptoms or signs of systemic lupus erythematosus. A diagnosis of subacute cutaneous lupus erythematosus was made on the basis of the clinical and histological features, positive anti-Ro antibody and a mildly elevated erythrocyte sedimentation rate. All other investigations, including complement studies, were normal. She has responded well to treatment with 0.5% alclometasone ointment and photoprotection.     

Subacute cutaneous lupus erythematosus

A large part of James N. Gilliam's abbreviated investigative career was devoted to testing a hypothesis that strong relationships do exist between the cutaneous and systemic manifestations of lupus erythematosus (LE). As a result of clinical observations made during his early studies designed to test this hypothesis, he introduced the term “subacute cutaneous lupus erythematosus” (SCLE) to designate a clinically distinctive nonscarring type of histologically confirmed cutaneous LE that he felt might represent a cutaneous marker for a discrete subset of LE patients.¹ A series of studies carried out in our and other laboratories have since confirmed that patients who develop SCLE skin lesions do indeed share other clinical, pathologic, serologic, and immunogenetic features. Dr. Gilliam died on June 6, 1984, before the full impact of his initial clinical observations had been fully recognized. I would, therefore, like to dedicate the following discussion of the clinical and laboratory features of patients with SCLE skin lesions to his memory.     

Subacute cutaneous lupus erythematosus (SCLE) presenting in childhood

A 13-year-old boy presented with erythematous scaly plaques on the face and extremities with history of photosensitivity of 7-years duration. There was no history of oral ulcers or joint pains. Although the histopathological findings were inconclusive, a positive lupus band test confirmed the diagnosis of subacute cutaneous lupus erythematosus.     

Subacute cutaneous lupus erythematosus as a paraneoplastic syndrome

We report on a 68-year old patient suffering from subacute cutaneous lupus erythematosus as a paraneoplastic syndrome. After successful surgery of a gastric cancer at the gastrojejunal borderline (state after Billroth II), the skin lesions healed fast and completely.     

Subacute cutaneous lupus erythematosus in childhood

We report a 7-year-old girl who presented with erythematous-infiltrated, figurate, well-defined lesions over sun-exposed skin and antinuclear and Ro/SSA antibodies. Lupus band test revealed granular IgM and microgranular C3 deposits at the dermoepidermal junction. Histopathologic examination of lesional skin showed orthohyperkeratosis, epidermal atrophy, widespread hydropic degeneration of the epidermal basal cell layer, and a dermal perivascular lymphohistiocytic infiltrate. The clinical, immunopathologic, and histopathologic findings were consistent with the diagnosis of annular-polycyclic variant of subacute cutaneous lupus erythematosus (SCLE). Treatment with hydroxychloroquine cleared the cutaneous lesions. We report this patient because SCLE is extremely rare in childhood, and discuss the two previous cases reported in the literature.     

Subacute cutaneous lupus erythematosus with pityriasis-like cutaneous manifestations

A 57‐year‐old woman was seen in our department in September 1999. At the time of our observation, she complained of fever and malaise and presented many erythematous and squamous lesions on sun‐exposed areas. On the upper third of the back ( Figs 1, 2 ), she presented a wide patch with irregular borders, due to many coalescing small purplish‐red lesions. Each lesion was covered with branny scales and, on palpation, revealed a variable degree of infiltration. Few areas of uninvolved skin could be seen inside the main patch. Beyond this main patch, small individual scattered lesions with a net‐like distribution were detected.

Figure 1 Open in figure viewer PowerPoint Wide purplish‐red patch and individual scattered lesions of the upper back covered with branny scales     

Subacute cutaneous lupus erythematosus associated with leflunomide

A skin eruption consistent with subacute cutaneous lupus erythematosus (SCLE) occurred in a patient taking leflunomide for rheumatoid arthritis. The eruption resolved after discontinuation of the medication. Suppression of tumor necrosis factor (TNF)-effector mechanisms by leflunomide may have played a role in the pathogenesis of this disorder.     

Subacute cutaneous lupus erythematosus associated with phenytoin

Subacute cutaneous lupus erythematosus is a well recognized subset of systemic lupus erythematosus. It is characterized by a nonscarring, papulosquamous or annular eruption in a photosensitive distribution. Several cases, thought to be caused by drugs, have been reported. We report a case of subacute cutaneous lupus erythematosus caused by phenytoin, which has not previously been associated with this condition.