Article ; Online: Blisters and Loss of Epidermis in Patients With Lupus Erythematosus: A Clinicopathological Study of 22 Patients.
2015 Volume 94, Issue 46, Page(s) e2102
Abstract: The nosology of bullous lesions or equivalents (vesicles, erosions, and crusts) in patients with lupus erythematosus (LE) is rarely addressed.The primary aim of this study was to draw up a precise phenotypic inventory of such skin lesions; the secondary ... ...
Abstract | The nosology of bullous lesions or equivalents (vesicles, erosions, and crusts) in patients with lupus erythematosus (LE) is rarely addressed.The primary aim of this study was to draw up a precise phenotypic inventory of such skin lesions; the secondary objective was to assess a potential relationship between the different types of loss of epidermis and extracutaneous lupus manifestations.We conducted a retrospective multicenter study including 22 patients with definite LE and bullous lesions or equivalents. All biopsies were reviewed. Patients were recruited in the dermatology departments of 6 centers. Patients were included if they met the diagnosis of systemic LE according to American College of Rheumatology and/or Systemic Lupus International Collaborating Clinics criteria or diagnosis of cutaneous LE based on classic clinical criteria and/or histological ascertainment of LE. Patients were recruited through clinician's memory and photographic collections.Three clinico-pathological patterns could be individualized. First, toxic epidermal necrolysis (TEN)-like, sheet-like, skin detachment; sun-exposure, mild mucosal involvement, and dermal mucin deposition allow differential diagnosis with classical Lyell syndrome. Second, vesiculo-bullae and/or crusting occurring on typical lesions of subacute cutaneous lupus erythematosus or chronic cutaneous lupus erythematosus. Third, tense vesicles and/or blisters with an underlying neutrophilic dermatosis and a usual response to dapsone.A careful analysis of 22 LE patients with epidermal detachment reveals 2 main pathomechanisms: a classic LE interface dermatitis, which can be hyperacute and lead to TEN-like skin detachment; and a neutrophilic dermatosis, with tense vesicles and/or blisters, including classic bullous LE. |
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MeSH term(s) | Acute Disease ; Adolescent ; Adult ; Aged ; Blister/etiology ; Blister/immunology ; Blister/pathology ; Child ; Epidermis/immunology ; Epidermis/pathology ; Female ; Humans ; Lupus Erythematosus, Cutaneous/immunology ; Lupus Erythematosus, Cutaneous/pathology ; Lupus Erythematosus, Discoid/immunology ; Lupus Erythematosus, Discoid/pathology ; Male ; Middle Aged ; Retrospective Studies ; Young Adult | |||||
Language | English | |||||
Publishing date | 2015-11-02 | |||||
Publishing country | United States | |||||
Document type | Journal Article ; Multicenter Study ; Observational Study | |||||
ZDB-ID | 80184-7 | |||||
ISSN | 1536-5964 ; 0025-7974 | |||||
ISSN (online) | 1536-5964 | |||||
ISSN | 0025-7974 | |||||
DOI | 10.1097/MD.0000000000002102 | |||||
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Database | MEDical Literature Analysis and Retrieval System OnLINE |
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