21 Management of skin involvement in SLE

• Published in: Lupus science & medicine 2023-09, Vol.10 (Suppl 2), p.A11-A12
• Main Author: Antonio Guilabert Vidal
• Format: Article
• Language: English
• Subjects: Arthritis; Educational objectives; Lupus
• ISSN: 2053-8790
• DOI: 10.1136/lupus-2023-la.21

Case 1: Blisters in systemic lupus erythematosusSkin lesions can be very heterogeneous in systemic lupus erythematosus (SLE). Clinicopathological correlation is crucial to identify the type of cutaneous lesion since it provides prognostic and therapeutic implications. Blistering lesions are rare in lupus erythematosus; however, they can be difficult to characterize and the cutaneous differential diagnosis is wide. The term ‘bullous lupus’ can be confusing since it may even reflect different immune mechanisms that need specific management. A 42-year-old with a 10-month history of hand arthritis and positivity for antinuclear antibodies (ANA), anti-RNP and anti-Sm, presented with a 2-month history of cutaneous lesions affecting her upper trunk and upper limbs. Vesicle and blisters were observed on the aforementioned sites. She had been treated with non-steroidal anti-inflammatory drugs and short pulses of prednisone that improved partially her skin lesions. The lesions resolved without scarring but leaving hypopigmentation.Learning ObjectivesDemonstrate the clinical differential diagnosis of blisters in SLEDescribe the main immunopathologic findings of blistering eruptions in SLEExplain the main features of bullous systemic lupus erythematosusDiscuss the extracutaneous associations of blistering eruptions in SLEDescribe the treatment of bullous systemic lupus erythematosusCase 2: Hand lesions in SLEHand lesions are relatively common in patients with SLE. Since these lesions are not always biopsied (especially those of the digits) a correct characterization may be lacking. These lesions can appear in patients with or without SLE. The differential diagnosis includes vasculitis, vasculopathy, chilblain lupus and palmoplantar lupus. Although localized, they are usually painful with functional impairment of loss of quality of life. Among them, the most common lesions are chilblain lupus. Response to topical treatment and antimalarials is typically poor. Chilblain lupus may not respond as well to systemic therapy compared to other visceral manifestations of SLE, hence being a treatment challenge both for rheumatologists and dermatologists. A 40-year-old woman, with an 8-year history of cutaneous lesions in the face and arms (diagnosed of cutaneous lupus erythematosus by biopsy), arthritis and ANA+, treated with hydroxychloroquine and variable doses of prednisone, was admitted in the rheumatology department due to headache and visual loss with bilateral papilledema