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lupus panniculitis (lupus erythematosus profundus)
Severe form of discoid lupus, but may occur in systemic lupus erythematosus.
Pathology: (dermatopathology)
-> subcutaneous tissue
1) necrobiosis with fibrinoid deposits
2) dense lymphocytic infiltrates
3) late lesions
a) hyalinization of fat lobules
b) mucinous deposits
c) vasculitis (rare)
Clinical manifestations:
1) firm, circumscribed nodules or plaques of face, scalp, breasts, upper arms, thighs & buttocks
a) generally no grossly visible epidermal changes [1]
b) indurated subcutaneous edema with overlying erythema [2]
c) lesions my ulcerate
d) lesions may be slightly tender or painful
e) lesions may precede or follow lesions of discoid lupus by several years
2) most patients also have lesions typical of discoid lupus
3) 35% of patients may have mild SLE
* image [3]
Differential diagnosis:
1) morphea
2) erythema nodosum
3) sarcoid
Management: (same as for discoid lupus)
1) topical corticosteroids
2) intralesional triamcinolone acetonide 3-5 mg/mL
3) hydroxychloroquine 100 mg PO QD, up to 6.5 mg/kg/day, plus (if needed) quinacrine hydrochloride 100 mg PO QD
4) etretinate 1 mg/kg/day
5) prevention: topical sunscreens (SPF 30)
General
discoid lupus (chronic cutaneous lupus erythematosus)
panniculitis
References
- Color Atlas & Synopsis of Clinical Dermatology, Common
& Serious Diseases, 3rd ed, Fitzpatrick et al, McGraw Hill, NY,
1997, pg 356-57
- Medical Knowledge Self Assessment Program (MKSAP) 17,
American College of Physicians, Philadelphia 2015
- Chen T, Ma DL
Images in Dermatology
Linear and Annular Lupus Panniculitis of the Scalp.
JAMA Dermatol. Published online February 15, 2023.
PMID: 36790778
https://jamanetwork.com/journals/jamadermatology/fullarticle/2801095