<p>Vesiculobullous diseases in relation to lupus erythematosus</p>

Abstract

Vesiculobullous lesions in lupus erythematosus (LE) are a rare cutaneous manifestation of cutaneous and/or systemic LE with variable presentation. While the minor forms of LE-associated vesiculobullous disease may cause disfigurement and discomfort, the severe forms can present with hyperacute reaction and life-threatening consequences. Specific LE and aspecific cutaneous LE are defined by the presence or absence of interface change on histopathology that can be applied to vesiculobullous diseases in relation to LE. However, the diagnosis of LE-associated vesiculobullous diseases remains difficult, due to the poorly defined nosology and the similarities in clinical and immunohistopathological features among them. Herein, we thoroughly review the topic of vesiculobullous skin disorders that can be encountered in LE patients and organize them into four groups: LE-specific and aspecific vesiculobullous diseases, LE-related autoimmune bullous diseases, and LE in association to non-autoimmune conditions. We sought to provide an updated overview highlighting the pathogenesis, clinical, histological, and immunopathological features, laboratory findings, and treatments and prognosis among vesiculobullous conditions in LE.

Recurrent Stevens–Johnson syndrome in a patient with systemic lupus erythematosus: a case report

“…In accordance with the Systemic Lupus International Collaborating Clinics (SLICC) diagnostic criteria for SLE, ACLE is associated with the presence of extra-cutaneous involvement. 19 Our patient presented, at the time, with only mucocutaneous manifestations.…”

“…Another difference is mucosal involvement, which is more extensive in drug-induced SJS/TEN than in ACLE. 19 Our patient had mucosal involvement and the onset of his condition was acute. ACLE can also present as target lesions and erythema multiforme-like lesions; 19 however, the patient had no such lesions on examination.…”

“… 19 Our patient had mucosal involvement and the onset of his condition was acute. ACLE can also present as target lesions and erythema multiforme-like lesions; 19 however, the patient had no such lesions on examination. In accordance with the Systemic Lupus International Collaborating Clinics (SLICC) diagnostic criteria for SLE, ACLE is associated with the presence of extra-cutaneous involvement.…”

A case of toxic epidermal necrosis–like cutaneous eruption as the first manifestation and clue to the diagnosis of systemic lupus erythematosus: A case report

“…Rutnin and Chanprapaph 9 classify vesiculobullous diseases in LE patients into four categories: LE-specific and aspecific vesiculobullous diseases, LE-related autoimmune bullous diseases, and LE in association with non-autoimmune conditions. Our patient’s clinical presentation, as well as specific histologic and serologic findings, meets Rutnin et al’s diagnostic features for LE-specific vesiculobullous diseases, specifically TEN-like LE.…”

“…In conclusion, this is one of few reported cases of TEN-like skin eruption occurring as the first manifestation of SLE. 1 , 8 , 9 , 11 – 15 TEN-like dermatoses should be included in the differential of acute sheet-like epidermal detachment, especially in the absence of mucosal involvement, high-risk drug ingestion and hemodynamic instability. Positive autoimmune serology may further support the diagnosis of TEN-like LE.…”