Subacute cutaneous lupus erythematosus
Skin lesions of subacute cutaneous lupus erythematosus (SCLE) are annular or psoriasiform. There is no follicular plugging, no scarring, and little atrophy, all of which are frequently noted in CCLE. Patients with SCLE may have a few of the criteria of SLE as defined by the American Rheumatism Association, including photosensitivity, arthralgias, serositis, renal disease, and serologic abnormalities; practically all have anti-Ro (SS-A) and most have anti-La (SS-B) antibodies. The serious criteria of SLE are uncommon: severe vasculitis, severe CNS disease, or progressive renal disease. Nonetheless, most patients have a mild form of SLE so that SCLE is not a purely cutaneous disease. The clinical skin lesions are the distinctive feature of SCLE.
Skin lesions Two Types Psoriasiform Papulosquamous, sharply defined, with slight delicate scaling, evolving into bright red confluent plaques that are oval, arciform, or polycyclic, just as in psoriasis.
Annular Bright red annular lesions with central regression and little scaling. In both there may be telangiectasia, but there is no follicular plugging and less induration than in CCLE. Lesions resolve with slight atrophy (no scarring) and hypopigmentation.
Other Lesions Periungual telangiectasia, diffuse nonscarring alopecia.
Distribution Scattered, disseminated in lightexposed areas: shoulders, extensor surface of the arms, dorsal surface of the hands, upper back, V-neck area of the upper chest.
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