ABSTRACT
El lupus eritematoso es una dermatosis inflamatoria, crónica, aguda o subaguda que evoluciona por brotes. Puede afectar a todos los órganos pero más frecuentemente a la piel. Presentamos a dos pacientes con lesión en forma de placa, localizada en zona interna y media del borde libre palpebral inferior, de bordes elevados, depresión central con fondo costroso y pérdida de las pestañas a ese nivel. Se decide -por la localización, extensión de la lesión, los antecedentes personales y la aplicación de tratamientos previos sin mejoría del cuadro clínico- realizar biopsia incisional para un mejor estudio. Los resultados anatomopatológicos revelaron el diagnóstico de lupus discoide palpebral. La evolución posterior al tratamiento médico fue satisfactoria, sin recidiva de la lesión durante el primer año de seguimiento.
Erythematosus lupus is an inflammatory dermatosis of chronic, acute or subacute nature that occurs in outbreaks. It can affect all the body organs, but mainly the skin. Here are two patients with plaque-form lesions located in the internal middle area of the free inferior palpebral border, thick contours, central depression with scabby bottom and loss of eyelash. Taking into account the location, the extension of the lesion, personal histories and application of previous treatment without improved clinical picture, it was decided to perform incisional biopsy for better examination. The anatomopathological results showed the diagnosis of palpebral discoid lupus. The recovery of the patient was satisfactory after the medical treatment, with no relapse during the first follow-up year.
Subject(s)
Humans , Female , Middle Aged , Lupus Erythematosus, Cutaneous/diagnosis , Lupus Erythematosus, Discoid/diagnosis , Carcinoma, Basal Cell/diagnosis , Eyelid Neoplasms/diagnosis , Lupus Erythematosus, Systemic/diagnosisABSTRACT
BACKGROUND: It has been observed that patients with systemic lupus erythematosus and discoid lesions have a milder systemic disease. OBJECTIVE: To compare the clinical, demographic and autoantibody profile of systemic lupus erythematosus patients with and without discoid lesions. METHODS: We carried out a retrospective study involving 288 systemic lupus erythematosus patients who met at least four classification criteria of the American College of Rheumatology for systemic lupus erythematosus, comparing the clinical, serological and demographic factors between patients with and without discoid manifestations. RESULTS: Of the 288 patients, 13.8% had discoid lesions. Univariate analysis found no differences in the prevalence of malar rash, photosensitivity, arthritis, serositis, leukopenia, lymphopenia and hemolytic anemia or anemia of the central nervous system (p = ns). Renal lesions were more common in those without discoid lesions (p =0.016), and hemolysis (p<0.0001) was more common in those with discoid lesions. Regarding the profile of autoantibodies, only the anti-RNP antibody was more common in those with discoid events (p =0.04). In a logistic regression study, only the renal lesions and anti-RNP maintained their associations with discoid manifestations. CONCLUSION: Patients with lesions of systemic lupus erythematosus and discoid lesions have lower prevalence of renal involvement and a greater presence of anti RNP. .
FUNDAMENTOS: Existe a observação de que pacientes com lúpus eritematoso sistêmico e lesões discoides têm uma doença sistêmica mais branda. OBJETIVO: Comparar o perfil clínico, demográfico e de autoanticorpos de pacientes com lúpus eritematoso sistêmico com e sem lesões discoides. MÉTODOS: Estudo retrospectivo de 288 pacientes com lúpus eritematoso sistêmico que satisfizeram pelo menos 4 critérios classificatórios do Colégio Americano de Reumatologia para o diagnóstico de lúpus eritematoso sistêmico, comparando-se os achados clínicos, sorológicos e demográficos entre pacientes com e sem manifestações discoides. RESULTADOS: Dos 288 pacientes, 13,8% tinham lesões discoides. Na análise univariada não se encontraram diferenças quanto à prevalência de eritema malar, fotossensibilidade, artrite, serosite, leucopenia, linfopenia e anemia hemolítica ou de sistema nervoso central (p=ns). Lesões renais foram mais comuns naqueles sem lesão discoide (p =0,016), e a hemólise (p<0.0001) foi mais comum nos com lesão discoide. No que se refere ao perfil de autoanticorpos apenas o anticorpo anti-RNP foi mais comum naqueles com manifestações discoides (p=0,04). Em estudo por regressão logística, só as lesões renais e o anticorpo anti-RNP mantiveram suas associações com manifestações discoides. CONCLUSÃO: Pacientes de lúpus eritematoso sistêmico com lesões discoides têm menor prevalência de envolvimento renal e uma maior presença do anticorpo anti RNP. .
Subject(s)
Adolescent , Adult , Aged , Female , Humans , Male , Middle Aged , Young Adult , Lupus Erythematosus, Discoid/diagnosis , Lupus Erythematosus, Systemic/diagnosis , Autoantibodies/blood , Logistic Models , Lupus Erythematosus, Discoid/immunology , Lupus Erythematosus, Systemic/immunology , Prognosis , Retrospective Studies , Risk FactorsABSTRACT
O lúpus eritematoso cutâneo crônico, caracterizado, sobretudo, pelo lúpus discoide, é uma entidade clínica incomum, porém de elevada prevalência em mulheres em idade fértil. A sua etiologia é desconhecida, mas fatores genéticos, autoimunes, hormonais e ambientais compõem o processo fisiopatológico da doença. Os meios diagnósticos utilizados para que se possa iniciar o tratamento específico, composto de protetores solares, corticosteroides tópicos e, se preciso, medicações sistêmicas, principalmente os antimaláricos, são o exame clínico, a imunofluorescência direta e o estudo histopatológico. Este artigo descreve de maneira sucinta os principais aspectos epidemiológicos, clínicos, diagnósticos e terapêuticos do lúpus eritematoso cutâneo crônico, conforme revisão de literatura.
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Lupus Erythematosus, Cutaneous/diagnosis , Lupus Erythematosus, Cutaneous/physiopathology , Lupus Erythematosus, Cutaneous/drug therapy , Lupus Erythematosus, Discoid/diagnosis , Lupus Erythematosus, Discoid/etiology , Lupus Erythematosus, Discoid/physiopathology , Lupus Erythematosus, Discoid/drug therapyABSTRACT
Se presenta el caso de un paciente de 56 años, de sexo masculino, con historia de 30 años de evolución de la aparición de placas, infiltradas, arciformes, sin descamación, en lado izquierdo de la cara anterior del tórax, que aparecen y desaparecen sin ningún tratamiento. En la histopatología se observó la epidermis sin cambios y, en la dermis, un gran infiltrado dérmico superficial y profundo de linfocitos, con compromiso alrededor de los anexos. La tinción para mucina con azul alciano fue fuertemente positiva, la coloración para Borrelia sp. fue negativa y en la inmunohistoquímica se observó un infiltrado predominante de linfocitos T CD3+ CD5+ CD30-. Se han visto hallazgos histopatológicos similares en otras enfermedades cutáneas, como la infiltración linfocítica de Jessner, el eritema anular centrífugo, la erupción polimorfa lumínica, la mucinosis reticular eritematosa, linfomas y seudolinfomas, entre otras. Es difícil hacer el diagnóstico sólo por histopatología. Este cuadro, con infiltrado superficial y profundo de linfocitos T, con compromiso alrededor de los anexos, sin compromiso epidérmico, fuertemente positivo para mucina y negativo para Borrelia sp., es característico de lupus eritematoso tumidus.
Subject(s)
Immunohistochemistry , Lupus Erythematosus, Discoid , Lupus Erythematosus, Discoid/diagnosisSubject(s)
Humans , Female , Middle Aged , Lupus Erythematosus, Discoid/diagnosis , Pemphigus/diagnosis , Diagnosis, Differential , Dapsone/therapeutic use , Hydroxychloroquine/therapeutic use , Lupus Erythematosus, Discoid/pathology , Lupus Erythematosus, Discoid/drug therapy , Pemphigus/pathology , Pemphigus/drug therapyABSTRACT
To determine the frequency of sebaceous granulomas formation in discoid lupus erythematosus, Retrospective observational study. Departments of Dermatology and Pathology, Pakistan Institute of Medical Sciences, Islamabad. 100 cases of Discoid Lupus Erythematosus [DLE] spanning over two years and with the age range of 3 years to 70 years were examined for the presence of Sebaceous Granuloma. Other features of DLE like hyperkeratosis, follicular plugging, epidermal atrophy, basal layer vacuolization, basement membrane deposits, pigmentary incontinence, perivascular inflammation, periappendigeal inflammation, and collagen damage were also noted. Lupus erythematosus is an immune complex, type Ill hypersensitivity disease where antibodies are formed against native Deoxyribose Nucleic Acid [DNA]. The immune compexes are deposited in various organs and various sites causing marked pleotropism. If several systems are involved then the disease is named Systemic Lupus Erythematosus [SLE] and if skin is exclusively involve the term Discoid Lupus Erythematosus [DLE] is used. One of the several features of DLE includes periappengeal inflammation. This may at times completely wipe out sebaceous glands forming sebaceous granulomas. Out of these 100 cases 8 cases contained sebaceous granulomas. These granulomas were composed of epithelioid cells, foreign body giant cells containing partially digested sebaceous material and a few lymphoctytes. Sebaceous granulomas formation was seen in 8% cases of discoid lupus erythematosus. This feature must be recognized both by dermatologists and pathologist so that diagnosis of DLE may not be distracted and erroneous diagnosis due to presence of granulomas may not be rendered
Subject(s)
Humans , Middle Aged , Male , Female , Adult , Aged , Child, Preschool , Child , Adolescent , Lupus Erythematosus, Discoid/diagnosis , Granuloma/pathology , Retrospective StudiesABSTRACT
O lúpus discóide caracteriza-se por lesões limitadas à pele, eritematosas e recobertas por escamas brancas aderentes, que aparecem mais nas áreas expostas ao sol. Relatamos um caso de uma paciente feminina de 26 anos, com ardência e hiperemia dos olhos há meses, em tratamento de blefarite sem melhora. Apresentava ao exame lesões palpebrais ulceradas, que através do exame de imunofluorescência direta foram diagnosticadas como lúpus discóide. Diante de lesões palpebrais crônicas refratárias a tratamento clínico, mesmo na ausência de alterações nos exames complementares, deve-se realizar a biópsia incisional para elucidação do caso, e se necessário, o exame de imunofluorescência direta.
Discoid lupus is characterized by erythematosus lesions limited to the skin, covered by adherent white scales, which rise at places more exposed to the sun. A case of a 26 year-old woman, who was suffering for months from redness and burning of the eyes, and was been treated for blepharitis without resolution is reported. On the eyelids exam, ulcerated lesions were found, that were diagnosed as discoid lupus by immunofluorescence. When faced with chronic lesions on the eyelids that do not respond to medical treatment, even if the ancillary exams are normal, the incisional biopsy must be performed to elucidate the diagnosis and, if necessary, immunofluorescence should be done as well.
Subject(s)
Adult , Female , Humans , Eyelid Diseases/diagnosis , Lupus Erythematosus, Discoid/diagnosis , Anti-Inflammatory Agents/therapeutic use , Blepharitis/diagnosis , Eyelid Diseases/drug therapy , Fluorescent Antibody Technique , Lupus Erythematosus, Discoid/drug therapy , Prednisone/therapeutic useSubject(s)
Humans , Male , Female , Adult , Middle Aged , Eyelid Diseases/diagnosis , Carcinoma, Basal Cell/diagnosis , Granuloma, Pyogenic/diagnosis , Hemangioma/diagnosis , Herpes Zoster Ophthalmicus/diagnosis , Keratoacanthoma/diagnosis , Keratosis, Seborrheic/diagnosis , Lupus Erythematosus, Discoid/diagnosis , Myxedema/diagnosis , Nevus/diagnosis , Sarcoma, Kaposi/diagnosis , Urticaria/diagnosisABSTRACT
Se describe un caso de lupus eritematoso discoide que comenzó en la infancia. El lupus eritematoso discoide es infrecuente en la edad infantil y se ha estimado que menos del 2 por ciento de los pacientes desarrollan la enfermedad antes de los 10 años. El trastorno es similar al lupus discoide del adulto, pero aparentemente presenta un riesgo elevado de progresar a lupus eritematoso sistémico
Subject(s)
Humans , Male , Child , Lupus Erythematosus, Discoid/diagnosis , Autoimmune Diseases , Lupus Erythematosus, Cutaneous/classification , Lupus Erythematosus, Discoid/drug therapy , Lupus Erythematosus, Discoid/pathologySubject(s)
Humans , Male , Female , Infant, Newborn , Infant , Child, Preschool , Adolescent , Lupus Erythematosus, Cutaneous/diagnosis , Lupus Erythematosus, Systemic/diagnosis , Lupus Erythematosus, Discoid/diagnosis , Acute Disease , Chronic Disease , Lupus Erythematosus, Cutaneous/immunology , Lupus Erythematosus, Systemic/immunology , Lupus Erythematosus, Discoid/immunology , Surveys and QuestionnairesSubject(s)
Humans , Female , Adult , Blepharitis/etiology , Lupus Erythematosus, Discoid/complications , Anti-Inflammatory Agents/therapeutic use , Antimalarials/therapeutic use , Blepharitis/diagnosis , Fluorescent Antibody Technique, Direct , Lupus Erythematosus, Discoid/diagnosis , Lupus Erythematosus, Discoid/drug therapy , Scalp/pathologyABSTRACT
One hundred and twenty-six patients with LE were studied. They were distributed as follows: 84 with DLE, 13 with SALE and 29 with SLE. Biopsies from the skin lesions were performed and submitted to DIF. Positive results were equal to 69,61.5 and 72.4 percent of the DLE,SALE and SLE cases, respectively. These data are in accordance with the literature. IgM was the most frequently found immunoglobulin, followed by the association IgM+C3.
Subject(s)
Humans , Male , Female , Child , Adolescent , Adult , Middle Aged , Immunoglobulins/analysis , Lupus Erythematosus, Discoid/immunology , Lupus Erythematosus, Cutaneous/immunology , Lupus Erythematosus, Systemic/immunology , Lupus Erythematosus, Discoid/diagnosis , Reproducibility of Results , Sensitivity and Specificity , Lupus Erythematosus, Cutaneous/diagnosis , Lupus Erythematosus, Systemic/diagnosis , Fluorescent Antibody Technique, DirectABSTRACT
Presentamos un caso de Lupus eritomatoso discoideo crónico, de localización única en párpados, en un varón de 45 años. Se presenta el caso por su localización infrecuente, y su tratamiento exitoso con talidomida y corticosteroides orales
Subject(s)
Humans , Male , Middle Aged , Lupus Erythematosus, Discoid/drug therapy , Methylprednisolone/therapeutic use , Eyelids/pathology , Thalidomide/therapeutic use , Lupus Erythematosus, Discoid/diagnosis , Methylprednisolone/administration & dosage , Thalidomide/administration & dosageABSTRACT
Baseados em dados epidemiológicos imunopatológicos e imunológicos, os autores expoöem seu ponto de vista, acreditando que näo ocorra no fogo sevalgem (pênfigo foliáceo endêmico) a verdadeira síndrome de Senear-Usher
Subject(s)
Facial Dermatoses/diagnosis , Lupus Erythematosus, Discoid/diagnosis , Pemphigus/diagnosisABSTRACT
Se investigó por el método de inmunofluorescencia directa la presencia de IgM, IgG IgA, C3 en biopsias de piel de 304 pacientes con distintas enferemdades del tejido conectivo. Se analizó los resultados obtenidos, se realizó la correlación clínico patológica y se revisó la bibliografía con respecto a: lupus discoide crónico, enfermedad superpuesta del tejido conectivo, LES y Artritis reumatoidea. En los resultados se menciona especialmente el test de Banda para lupus que fue positivo en piel lesionada en el 100 por ciento de casos de lupus discoide crónico. En piel clinicamente sana del borde cubital de la mano izquierda el test de banda fue positiva en: 89 por ciento de pacientes con enfermedad superpuesta del tejido conectivo, 57 por ciento de LES y 7,6 por ciento de artritis reumatoidea. El mayor número depacientes con lupus y test de banda positivo presentaron signos de actividad de enfermedad. Se encontró signos clínicos de lesión renal con mayor frecuencia en pacientes con test de banda positivo con respecto a los pacientes negativos. Se encontró test de banda positivo y anticuerpos antinucleares fijos en pacientes con enfermedad del tejido conectivo superpuesta y en pacientes con lupus eritematoso sistémico