“…Cases which began as the systemic disease were reported in the earlier literature by Siemens [2] and Ramel [3], Siemens described a 12-year-old boy with loss of weight, pains, psychic lability, low fever, many enlarged lymph glands and a cutaneous eruption resembling that of systemic lupus erythem atosus. One year later there were skin lesions compatible with a diagnosis of chronic discoid lupus erythe matosus and no signs of systemic involvement were present.…”