Hypertrophic lupus erythematosus: a clinicopathological study of 14 cases

Background:  Hypertrophic lupus erythematosus (HLE) is a distinct and rare subset of lupus erythematosus (LE). It is characterized by verrucous lesions, chronic in its course, and resistant to treatment. The purpose of this study was to identify clinical and histological characteristics of HLE. Meth...

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Published in:Journal of cutaneous pathology 2003-08, Vol.30 (7), p.443-448
Main Authors: Daldon, Patrícia Érica Christofoletti, De Souza, Elemir Macedo, Cintra, Maria Letícia
Format: Article
Language:English
Subjects:
Adult
Biological and medical sciences
Brazil - epidemiology
Female
Follow-Up Studies
Hospitals, University
Humans
Hyperplasia
Hypertrophy
Lupus Erythematosus, Discoid - complications
Lupus Erythematosus, Discoid - epidemiology
Lupus Erythematosus, Discoid - pathology
Male
Medical sciences
Middle Aged
Retrospective Studies
Sarcoidosis. Granulomatous diseases of unproved etiology. Connective tissue diseases. Elastic tissue diseases. Vasculitis
Skin - pathology
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Summary:Background:  Hypertrophic lupus erythematosus (HLE) is a distinct and rare subset of lupus erythematosus (LE). It is characterized by verrucous lesions, chronic in its course, and resistant to treatment. The purpose of this study was to identify clinical and histological characteristics of HLE. Methods:  We review our experience with 14 cases of HLE identified in a group of 220 patients with different forms of LE, at the UNICAMP Hospital, between 1976 and 2002. Results:  All patients presented verrucous plaques concomitantly with discoid lesions. The most common sites of involvement were the face and the arms. Histology of HLE lesions revealed pseudoepitheliomatous hyperplasia engulfing elastotic material. Elastic fibers were seen in migration throughout the epidermis. Classic features of LE were noted in all cases. Three of the patients developed hyperkeratotic papules with central keratinous plug on their arms at the previous LE sites. These lesions resemble clinically and histopathologically keratoacanthomas. In one patient, HLE lesion progressed to squamous cell carcinoma (SCC), 26 years after the onset of the disease. Conclusions:  Transepithelial elimination of the elastotic material may be a feature of HLE. Some HLE lesions may present as keratoacanthoma, but classical features of LE aid the correct diagnosis. SCC may arise on a long‐standing HLE lesion; therefore HLE requires clinical and histopathological follow up.
ISSN:0303-6987
1600-0560
DOI:10.1034/j.1600-0560.2003.00082.x