Subacute Cutaneous Lupus Erythematosus

Papulosquamous (psoriasiform) pattern:
extensive involvement of the upper chest and confluence to form wide patches

involvement of the upper back. Click for details

Clinical Background:

A 34 year old male patient. SLE onset at the age of 26 with arthralgia, malar rash, leukopenia, thrombocytopenia, renal involvement with nephrotic syndrome, antinuclear and anti-nDNA antibodies.   Shortly after summer sun exposure, he presented with a symmetric eruption of papulo-squamous lesions with confluence to form wide plaques on the upper trunk and extensor surface of the arms.   A significant rise in the proteinuria accompanied the skin rash.
He was treated with high-dose oral steroids.   The rash rapidly resolved leaving scattered irregular areas of hypopigmentation and telangectasias.

Comments:

• photosensitivity is a frequent feature of SCLE;
• simultaneous flaring of SCLE and systemic lupus erythematosus may occur (approximately one fourth of cases according to Sontheimer and Gilliam's experience);
• a good response to systemic steroids is generally not the rule in SCLE (20% of the Callen and Klein's patients had "a measurable response of their cutaneous disease" with prednisone doses from 20 to 60 mg/d).