Lupus erythematosus in neonates, children, and adolescents

Neonatal LE should be suspected in any infant with an erythematous or scaling dermatitis, especially if it is distributed on the head and neck or if there is a history of photosensitivity. It should also be suspected in any infant with congenital heart block. A biopsy, though helpful, is not necessary since the diagnostic abnormality is the presence of anti-Ro(SSA) antibodies in infant's serum. When the disease is diagnosed, the infant can be effectively treated with a mild topical steroid and sun avoidance, with or without sunscreens, until the age of 12 months when the autoantibodies have presumably degraded. The child then should be observed periodically through adulthood for the onset of SLE. Mothers of infants with neonatal LE need to be checked for the presence of anti-Ro antibodies and SLE, Sjögren's syndrome, or thyroiditis. The recurrence of neonatal LE in some, but not all, future pregnancies must be anticipated. As more of these infants are followed into adulthood, we will learn how often neonatal LE is a marker for adult-onset SLE.