Collagen Vascular Diseases: Cutaneous Manifestations in Systemic Lupus Erythematosus (SLE)

Introduction

Systemic Lupus Erythematosus (SLE) is a chronic autoimmune disease affecting multiple organ systems, including the skin. Cutaneous manifestations are among the earliest signs of SLE and can provide diagnostic clues. This blog explores various skin lesions associated with SLE, their characteristics, and clinical implications.

Types of Skin Lesions in SLE

1. Acute Cutaneous Lupus Erythematosus (ACLE)

ACLE commonly presents as the characteristic 'butterfly rash' over the cheeks and nose. It occurs in association with systemic disease flares and may be triggered by sun exposure.

2. Subacute Cutaneous Lupus Erythematosus (SCLE)

SCLE is marked by annular or psoriasiform plaques predominantly affecting sun-exposed areas. Unlike ACLE, SCLE patients often have mild systemic involvement.

3. Chronic Cutaneous Lupus Erythematosus (CCLE)

CCLE includes discoid lupus erythematosus (DLE), which manifests as erythematous, scaly plaques that can lead to scarring and pigmentary changes.

Diagnosis & Management

Diagnostic Approach

• Clinical examination and history taking
• Skin biopsy for histopathology
• Serological tests, including ANA and anti-dsDNA

Management Strategies

• Sun protection with broad-spectrum sunscreens
• Topical corticosteroids and calcineurin inhibitors for localized lesions
• Systemic immunosuppressants for extensive disease involvement