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EPIDEMIOLOGY: Subacute cutaneous lupus erythematosus (SCLE) makes up 5-10% of all cases of lupus erythematosus. About half of the patients with SCLE have systemic symptoms. It is more common in Caucasians and there is female predominance (F:M=2.3:1). The mean age at diagnosis is around 40 years.

CLINICAL FEATURES: The skin lesions of SCLE are non-indurated, erythematous, scaling, and distributed symmetrically over wide areas of the body. The most common sites are face, neck, upper back and chest, shoulders, externsor surfaces of arms, hand, and fingers. There is increased photosensitivity with exacerbation of lesions during spring and summer months.

Lack of induration is an important distinguishing feature between SCLE (non-indurated) and discoid LE (indurated). The lesions may acquire psoriasiform appearance. The advancing border of the lesions may show crusting and vesiculation. A small proportion of SCLE patients (about 10-15%) may develop discoid lesions on scalp and face or malar rash.

SCLE is associated with increased incidence of HLA-DR2, HLA-DR3, HLA-B8, and HLA-A1. There is close association with inherited homozygous deficiency of C2 and C4 components of complement. Patients with SCLE show antinuclear antibodies, anti-Ro (SS-A) antibodies, and anti-La (SS-B) antibodies. SCLE pursues a mild course in most patients; however, severe systemic manifestations may occur, especially in patients with papulosquamous SCLE. There is increased incidence of Rheumatoid arthritis and Sjogren's syndrome in SCLE.

SCLE has been seen in association with numerous diseases, including: porphyria cutanea tarda; hepatitis B; radiation therapy; squamous cell carcinoma of head and neck; carcinoma of breast; hepatocellular carcinoma; pulmonary cancer; inclusion body myositis and interstitial myositis; and following therapy with numerous drugs.

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