Chronic Cutaneous Lupus Erythematosus

Long-standing Perniotic Lupus Erythematosus on the nose.


Clinical Background:

A 44 year old patient who complained of erythematous tumid plaques on the nose and malar areas for 16 years.  A first cutaneous biopsy was consistent with Lupus Erythematosus and direct immunofluorescence showed IgG, IgA, IgM and C3 deposition in a granular, band-like array along the dermoepidermal junction.
The patient had no systemic symptoms or laboratory evidence of SLE and therefore only received hydroxychloroquine (200mg/d). During the following15 years of uninterrupted hydroxychloroquine treatment the malar plaques disappeared.  However at the time of our first visit she had a tumid erythematous plaque covering almost the entire surface of the nose with very slight follicular plugging which was more reminiscent of a "lupus pernio" rather than a cutaneous LE: a second biopsy was therefore performed which confirmed the initial diagnosis of cutaneous LE.
The patient was then administered low-dose prednisone with slight improvement but incomplete clearing of the tumid lesions and finally argon laser treatment was attempted with satisfying results.

All contents copyright of the "On-line Archives of Rheumatology", 1996