Verrucous lupus erythematosus: Ultrastructural studies on a distinct variant of chronic discoid lupus erythematosus

Ten patients with classic discoid lupus erythematosus of the face associated with verrucous, papulonodular lesions on the arms and hands were studied by electron microscopy. The ultrastructural findings on the verrucous lesions included apoptotic keratinocytes, intraepidermal lymphocytes, and gapping, detachment, and reduplication of the basal lamina. Also, tubuloreticular inclusion bodies were present in the endothelial cells. These observations, together with the clinical, histopathologic, and immunofluorescence findings, suggest that the verrucous lesions represent a rare, but distinct, variant of chronic discoid lupus erythematosus.     

Morphea with discoid lupus erythematosus

The presence of lupus erythematosus with morphea in the same patient has rarely been reported. In this case, we describe a woman with the overlap of discoid lupus erythematosus with superficial morphea, diagnoses that are supported by histopathologic features and laboratory studies.     

Verrucous cutaneous lupus erythematosus

An unusual case of cutaneous lupus erythematous with verrucous lesions is reported for its rarity and clinical interest.     

Multiple squamous cell carcinomas in lesions of discoid lupus erythematosus

Squamous cell carcinoma (SCC) is the most common skin cancer in black patients. In half of the cases, it is associated with predisposing factors. We present a patient who has been evaluated for thirty-nine years with a diagnosis of discoid lupus erythematosus (DLE) and has multiple SCCs. The lesions occurred in chronic hyperkeratotic lesions of DLE.     

T-cell subsets in lesions of systemic and discoid lupus erythematosus

In 6 patients with untreated systemic lupus erythematosus (SLE) in the progressive stage, and in 6 with discoid lupus erythematosus (DLE), an analysis of inflammatory infiltrates was performed in situ using the avidin-biotin-peroxidase complex (ABC) method with monoclonal antibodies. In all patients, over 75% of the infiltrates reacted with the pan T-cell antibody OKT3, but only sporadically with that of B-cell OKB7. In addition, a large number of the infiltrates were OKIal-positive, indicating that they were in an activated state. Many OKT8-positive cells were seen infiltrating the epidermis especially in the vicinity of basal keratinocytes. Staining for T-cell subsets revealed that the proportion of OKT8-positive cells (suppressor/cytotoxic) was from 2 to 3 fold higher than that of OKT4-positive cells (helper/inducer) in lesions of SLE. On the contrary, in DLE, a predominance of OKT4-positive cells (the OKT4/OKT8 ratio was from 1:1 to 3:1) was observed. Thus, our results provide further evidence that these 2 main types of LE show quite contrary findings on immunohistochemical analysis of T-cell subsets, and that besides the humoral immune mechanism, the cell-mediated immune mechanism may be involved in the pathogenesis of these disorders.     

Antioxidants in the treatment of patients with discoid lupus erythematosus

The authors present the data of biochemical studies of lipid peroxidation in 63 patients with discoid lupus erythematosus, validating the use of antioxidants combined with prednisolone and delagil in the treatment of such patients.     

Hypertrophic discoid lupus erythematosus

Hypertrophic discoid lupus erythematosus is a distinct form of chronic cutaneous (discoid) lupus, which is characterized by hyperkeratotic plaques that typically are observed over the face, arms, and upper trunk. We present the case of a 43-year-old man with verrucous plaques that were distributed symmetrically over the face, who initially was treated with oral antibiotics and topical glucocorticoids for acne vulgaris. A biopsy specimen confirmed the diagnosis of hypertrophic discoid lupus erythematosus. The clinical and histopathologic features of this clinical variant are reviewed.     

Keratin expression in discoid lupus erythematosus

Abstract 21 lesions from 16 patients with discoid lupus erythematosus (DLE) were examined immunohistologically using monoclonal antibodies to keratins (K). Markers of basal epithelial cells (the keratin conformation specific basal markers LH6 and LH8), differentiating keralino-cytes (K1 and K10), hyperproliferating keratinocytes (K16) and panepidermal keratin (K14), were used. A monoclonal antibody to type VII collagen was used as a guide to the stale of the basement membrane zone (BMZ). Keratin distribution in DLE differed from controls. Suprabasal cells were labelled by LH6 in 95% of specimens (19/20) and LH8 in 79% (15/19) in contrast to the basal distribution in normal skin. Reduction of suprabasal LL017 (K1) expression was seen in 59% (10/17) of lesions. An increase of LL025 (K16) expression was seen in 33% (5/15) of specimens. Where LL025 (K16) expression was increased, LL017 (K1) expression was reduced in 80% (4/5). Dermal colloid bodies expressed both basal and suprabasal keratins and were present at sites of maximal basement membrane disruption. These findings are consistent with a model of DLE in which there is an increase in the proliferative basal compartment. This compartment and the associated BMZ suffer fragmentation and loss of colloid bodies to the dermis which express a range of keratins not uniformly associated with basal keratinocytes.     

HLA antigens in discoid lupus erythematosus

HLA-A, B, C and Bf typing was performed in 55 cases of Discoid Lupus Erythematosus (DLE). When both the sex and age of the patient at the onset of the disease were taken into consideration (group I under 40 years, group II over 40), the following increases in antigen frequency were observed: group I: A2 in women, B5, A10 in men; group II: Aw19.2 in women, B8 in both sexes. Nevertheless, if the probability is multiplied by the number of antigens tested, these results are no longer significant.     

Verruciform xanthoma in association with discoid lupus erythematosus

Verruciform xanthoma (VX) is an uncommon lesion occurring primarily in the oral cavity. Cutaneous lesions are much less common and they preferentially arise on anogenital skin. They are not necessarily associated with a pre-existing inflammatory process. We report a VX in association with a long-standing lesion of discoid lupus erythematosus (DLE) on the scalp of a 34-year-old black woman. This association, which to our knowledge has not been previously reported, is consistent with the proposed pathogenetic mechanism of entrapment and subsequent degeneration of epithelial cells in the papillary dermis of VX. Histological distinction of VX from squamous cell carcinoma, with which this lesion may be clinically confused, is straightforward.     

Systemic lupus erythematosus with generalized chronic cutaneous (discoid) lupus erythematosus

A 24-year-old pregnant African-American woman had a 3-4 year history of chronic, scarring, hyperpigmented plaques on her scalp, face, trunk, and extremities. She complained of joint pain and fatigue. Clinical presentation, laboratory data, and histopathologic features were consistent with systemic lupus erythematosus in a patient with generalized chronic discoid lupus erythematosus. This subtype is a distinct lupus erythematosus subset that rarely develops renal disease and has a relatively benign but chronic course.