Cutaneous manifestations of lupus erythematosus: a practical clinicopathological review for pathologists

Abstract

Accurate diagnosis of connective tissue diseases is often challenging, and relies upon careful correlation between clinical and histopathological features, direct immunofluorescence studies and laboratory work‐up. Lupus erythematosus (LE) is a prototype of connective tissue disease with a variety of cutaneous and systemic manifestations. Microscopically, cutaneous LE is classically characterised by an interface dermatitis although other histopathological patterns also exist, depending upon the clinical presentation, location and chronicity of the skin lesions. In this article, we review the clinical, serological, histopathological and direct immunofluorescence findings in LE‐specific and LE non‐specific skin lesions, with an emphasis upon lesser‐known variants, newly described features and helpful ancillary studies. This review will guide general pathologists and dermatopathologists in accurately diagnosing and subclassifying cutaneous LE.

Progressive Skin Depressions in a Child’s Neck

“…Previous reports of LCAI have described biopsy results that may overlap considerably with this entity, including lobular lymphocytic inflammation, perieccrine lymphocytic inflammation, and mucin deposition . Other histopathologic features used to distinguish this entity from LCAI are liquefaction of basal epidermal cells, paraseptal lymphoid nodules around fat lobules containing germinal centers, and hyaline necrosis of fat . Otherwise, direct immunofluorescence in patients with lupus erythematosus panniculitis may show immunoreactive deposition at the dermoepidermal junction .…”

“…5 Other histopathologic features used to distinguish this entity from LCAI are liquefaction of basal epidermal cells, paraseptal lymphoid nodules around fat lobules containing germinal centers, and hyaline necrosis of fat. 6 Otherwise, direct immunofluorescence in patients with lupus erythematosus panniculitis may show immunoreactive deposition at the dermoepidermal junction. 6 Subcutaneous fat necrosis of the newborn, a panniculitis characterized by fat necrosis, is a rare benign fat disorder that usually affects full-term newborns.…”

“…6 Otherwise, direct immunofluorescence in patients with lupus erythematosus panniculitis may show immunoreactive deposition at the dermoepidermal junction. 6 Subcutaneous fat necrosis of the newborn, a panniculitis characterized by fat necrosis, is a rare benign fat disorder that usually affects full-term newborns. It presents with well-defined erythematous sclerotic nodular fat necrosis.…”

Inflammation of Actinic Keratoses Induced by Combination of Carboplatin and Paclitaxel: Two Case Reports

“…Selective inflammation of AK during chemotherapy is possibly a consequence of direct cytotoxicity of an active compound on atypical keratinocytes that accumulate ultraviolet-induced damage of deoxyribonucleic acid, but the exact mechanism of how different chemotherapeutics achieve this effect seems to be drug-dependent [ 13 ]. Alternative explanations of skin lesions (i.e., subacute lupus erythematosus, actinic lichen planus, cutaneous vasculitis, hypersensitivity drug reactions, drug-induced photosensitivity reactions, and photocontact dermatitis) were in both patients excluded on the basis of a history, typical clinical features of AK, and in the first case with the additional characteristic presence of atypical keratinocytes on histological examination [ 14 , 15 , 16 , 17 , 18 , 19 , 20 ].…”

Cutaneous Lupus Erythematosus: An Overview of Clinical Manifestations

“…Lupus erythematosus is a connective tissue disease with a diverse variety of cutaneous manifestations with the complex involvement of immunologic factors, genetic susceptibility, and environmental triggers exposure [4]. The etiology is typically defined by the interaction of these multiple factors that together trigger the development of the disease.…”