Creation and Validation of Classification Criteria for Discoid Lupus Erythematosus

Elman, Scott A.; Joyce, Cara; Braudis, Kara; Chong, Benjamin F.; Fernandez, Anthony P.; Furukawa, Fukumi; Hasegawa, Minoru; Kim, Hee Joo; Li, Sara J.; Lian, Christine G.; Szepietowski, Jacek C.; Werth, Victoria P.; Merola, Joseph F.

doi:10.1001/jamadermatol.2020.1698

Cited by 24 publications

(16 citation statements)

References 16 publications

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“… 5 , 11 Trichoscopy exam should start with dry trichoscopy as using an immersion fluid hydrates the scale. Trichoscopy reveals thick arborizing vessels, follicular keratotic plugs, follicular red dots, peripilar scale, and peripilar erythema 5 , 11 , 17 ( Figure 2 ). Blue gray speckled dots and blue-white veil are two features observed in patients with Fitzpatrick skin type IV–VI.…”

Section: Types Of Le Alopeciamentioning

confidence: 99%

Recent Insight on the Management of Lupus Erythematosus Alopecia

Desai¹,

Miteva²

2021

CCID

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Lupus erythematosus (LE) is a chronic autoimmune condition with a wide spectrum of clinical presentations. Alopecias, both non-scarring and scarring, frequently occur in the context of LE and can assume several different patterns. Furthermore, alopecia occurring with LE may be considered LE-specific if LE-specific features are present on histology; otherwise, alopecia is considered non-LE-specific. Non-scarring alopecia is highly specific to systemic LE (SLE), and therefore has been regarded as a criterion for the diagnosis of SLE. Variants of cutaneous LE (CLE), including acute, subacute, and chronic forms, are also capable of causing hair loss, and chronic CLE is an important cause of primary cicatricial alopecia. Other types of hair loss not specific to LE, including telogen effluvium, alopecia areata, and anagen effluvium, may also occur in a patient with lupus. Lupus alopecia may be difficult to treat, particularly in cases that have progressed to scarring. The article summarizes the types of lupus alopecia and recent insight regarding their management. Data regarding the management of lupus alopecia are sparse and limited to case reports, and therefore, many studies including in this review report the efficacy of treatments on CLE as a broader entity. In general, for patients with non-scarring alopecia in SLE, management is aimed at controlling SLE activity with subsequent hair regrowth. Topical medications can be used to expedite recovery. Prompt treatment is crucial in the case of chronic CLE due to potential for scarring and irreversible damage. First-line therapies for CLE include topical corticosteroids and oral antimalarials, with or without oral corticosteroids as bridging therapy. Second and third-line systemic treatments for CLE include methotrexate, retinoids, dapsone, mycophenolate mofetil, and mycophenolate acid. Additional topical and systemic medications as well as physical modalities used for the treatment of lupus alopecia and CLE are discussed herein.

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Section: Types Of Le Alopeciamentioning

confidence: 99%

Recent Insight on the Management of Lupus Erythematosus Alopecia

Desai¹,

Miteva²

2021

CCID

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“…Inclusion criteria were patients who met the following disease classification and/or inclusion terms for OLE, OLP, and other OLLs and were classified into the OLE, OLP, or control group. The diagnosis of OLE was made in patients presenting with typical discoid plaque based on the verified classification criteria for DLE and/or cases with oral lesions and positive lupus-associated serology (e.g., antinuclear antibodies, anti-double-stranded DNA, anti-Smith antibody) with or without systemic disease [32]. Patients who demonstrated classic white striae (reticulate pattern), erosive/ulcerative, or atrophic lesions with histology compatible with lichen planus according to the Modified World Health Organization criteria were classified as OLP [33].…”

Section: Methodsmentioning

confidence: 99%

Comparative Analyses of Clinical Features, Histopathology, and CD123 Immunohistochemistry of Oral Lupus Erythematosus, Lichen Planus, and Other Lichenoid Lesions

Chanprapaph¹,

Pomsoong²,

Tankunakorn³

et al. 2021

Dermatology

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Background: Oral lupus erythematosus (OLE) and oral lichen planus (OLP) are among the common causes of oral lichenoid lesions (OLLs). The differential diagnosis among causes of OLLs, particularly between OLE and OLP, is challenging as they have significant clinical and histopathological overlap. Objectives: To compare and summarize the clinical, histopathological, and direct immunofluorescence (DIF) findings between OLE, OLP, and other OLLs and to explore the diagnostic value of CD123 immunohistochemistry. Methods: A retrospective study on patients with OLE, OLP, and other OLLs was performed between January 2014 and December 2019. The baseline characteristics, the clinical, histopathological, and DIF features, as well as CD123 immunohistochemistry for plasmacytoid dendritic cells (PDCs) were statistically analyzed and compared between groups. Results: Of 70 patients, 12 had OLE, 39 had OLP, and 19 had other OLLs. Oral erosions/ulcers were the most common findings in all three groups. Red macules, telangiectases, and discoid plaques were more common in OLE patients, while OLP cases were typified by reticulated patches (p < 0.05). Additionally, white patches were found more often in other OLLs than in both OLE and OLP (p = 0.002). Histologically, mucosal atrophy, basal vacuolization, and perivascular infiltrate were observed in OLE, whereas OLP specimens possessed mucosal hyperplasia, hypergranulosis, and compact orthokeratosis (p < 0.05). Mucosal spongiosis was a histologic feature that favored other OLLs over OLE and OLP (p < 0.001). Data on DIF were nonspecific for all three conditions. For immunohistochemical staining, the median number of total CD123+ PDCs was observed to be higher in OLE than OLP in the mucosal-submucosal junction (MSJ) (p = 0.021), the superficial perivascular area (p = 0.026), and the superficial and deep perivascular areas (p = 0.001). Likewise, PDCs in clusters ≥2+ were seen in significantly higher numbers on OLE than OLP along the MSJ (p = 0.002), the superficial perivascular area (p < 0.001), as well as the superficial and deep perivascular areas (p = 0.011). CD123+ PDCs were found to be significantly more numerous in both OLE and OLP than other OLLs in all of the abovementioned areas (all p < 0.05). Conclusion: While there are some differences in the clinicopathological features between OLE, OLP, as well as other OLLs, a significant overlap remains. The quantity and distribution pattern of CD123 immunohistochemical staining has a diagnostic implication in differentiating OLE from OLP and other OLLs.

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“… 25% The whole layer of epidermis is necrotic, resulting in epidermal separation and a small amount of monocyte infiltration in the papillary layer of the dermis. DRESS [ 58 – 62 ] 2~6weeks Measles-like rash with small pustules and, in severe cases, erythroderma with extensive exfoliation of the skin, fever, enlarged lymph nodes, accompanied by fever and enlarged lymph nodes Eosinophilia, monocytosis, and thrombocytopenia Liver, kidney, lung, heart, lymph node, brain, eye, etc. 10% Keratinocyte necrosis, lymphocyte extravasation, surface sponge edema, interfacial vacuolar degeneration, dermal lymphocyte and eosinophil infiltration AGEP [ 65 – 69 ] 1~11days Joint, face, rash is aseptic pustule, less mucosal involvement, body temperature often >38 ℃ White blood cells and neutrophils are mostly elevated.…”

Section: Clinical Presentation Of Scarsmentioning

confidence: 99%

“…In addition to systemic complications, severe drug eruptions incorporating a large skin area can also produce severe sequelae. In a large retrospective cohort study [ 57 ], follow-up of adult patients with SJS/TEN revealed that nearly half of them had long-term sequelae, involving the eyes (corneal ulcers, cicatricial lesions, and shortening of the fornix and symblepharon), skin, gastrointestinal tract, genitals (erosion of genital mucosa may lead to vaginal adhesion), kidneys, lungs, and nails [ 58 ] (Fig. 2 ).…”

Section: Clinical Presentation Of Scarsmentioning

confidence: 99%

Current Perspectives on Severe Drug Eruption

Zhang

Lei

et al. 2021

Clinic Rev Allerg Immunol

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Adverse drug reactions involving the skin are commonly known as drug eruptions. Severe drug eruption may cause severe cutaneous adverse drug reactions (SCARs), which are considered to be fatal and life-threatening, including Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), acute generalized exanthematous pustulosis (AGEP), and drug reaction with eosinophilia and systemic symptoms (DRESS). Although cases are relatively rare, approximately 2% of hospitalized patients are affected by SCARs. There is an incidence of 2 to 7 cases/million per year of SJS/TEN and 1/1000 to 1/10,000 exposures to offending agents result in DRESS. However, the mortality rate of severe drug eruptions can reach up to 50%. SCARs represent a real medical emergency, and early identification and proper management are critical to survival. The common pathogenesis of severe drug eruptions includes genetic linkage with HLA-and non-HLA-genes, drug-specific T cell-mediated cytotoxicity, T cell receptor restriction, and cytotoxicity mechanisms. A multidisciplinary approach is required for acute management. Immediate withdrawal of potentially causative drugs and specific supportive treatment is of great importance. Immunoglobulins, systemic corticosteroids, and cyclosporine A are the most frequently used treatments for SCARs; additionally, new biologics and plasma exchange are reasonable strategies to reduce mortality. Although there are many treatment methods for severe drug eruption, controversies remain regarding the timing and dosage of drug eruption. Types, dosages, and indications of new biological agents, such as tumor necrosis factor antagonists, mepolizumab, and omalizumab, are still under exploration. This review summarizes the clinical characteristics, risk factors, pathogenesis, and treatment strategies of severe drug eruption to guide clinical management. Keywords Severe drug eruption • Stevens-Johnson syndrome • Toxic epidermal necrolysis • Acute generalized exanthematous pustulosis • Drug reaction with eosinophilia and systemic symptoms Abbreviations AGEP Acute generalized exanthematous pustulosis ALT Alanine aminotransferase APCs Antigen-presenting cells AST Aspartate aminotransferase CBZ Carbamazepine CCR CC-chemokine receptor COVID-19 Coronavirus disease 2019 CTL Cytotoxic T cells CXCR CXC chemokine receptor DiHS

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Creation and Validation of Classification Criteria for Discoid Lupus Erythematosus

Cited by 24 publications

References 16 publications

Recent Insight on the Management of Lupus Erythematosus Alopecia

Recent Insight on the Management of Lupus Erythematosus Alopecia

Comparative Analyses of Clinical Features, Histopathology, and CD123 Immunohistochemistry of Oral Lupus Erythematosus, Lichen Planus, and Other Lichenoid Lesions

Current Perspectives on Severe Drug Eruption

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