Cutaneous lupus erythematosus: a review of etiopathogenic, clinical, diagnostic and therapeutic aspects

Abstract

Cutaneous lupus erythematosus is an autoimmune disease of varied clinical expression, which may present as an exclusively cutaneous disease or be one of the multiple manifestations of systemic lupus erythematosus. Its classification includes acute, subacute, intermittent, chronic and bullous subtypes, which are usually identified based on clinical features and histopathological and laboratory findings. Other non-specific cutaneous manifestations may be associated with systemic lupus erythematosus and are usually related to disease activity. Environmental, genetic and immunological factors play a role in the pathogenesis of skin lesions in lupus erythematosus. Recently, considerable progress has been made in elucidating the mechanisms involved in their development, which allows for foreseeing future targets for more effective treatments. This review proposes to discuss the main etiopathogenic, clinical, diagnostic and therapeutic aspects of cutaneous lupus erythematosus, aiming to update internists and specialists from different areas.

Keywords: Autoimmune diseases; Lupus erythematosus, cutaneous; Lupus erythematosus, discoid; Lupus erythematosus, systemic; Panniculitis, lupus erythematosus.

Figure 1

Acute cutaneous lupus erythematosus. (A) Localized form: butterfly rash on the malar regions. (B) Disseminated form: symmetrical papulosquamous eruption, affecting the trunk and upper limbs.

Figure 2

(A) Subacute cutaneous lupus erythematosus: annular, erythematous, papulosquamous plaques, confluent on the chest and upper limbs. (B) Neonatal lupus erythematosus: circular and polycyclic erythematous plaques on the face.

Figure 3

Chronic cutaneous lupus erythematosus. (A) Discoid form located on the scalp, with cicatricial alopecia. (B) Discoid form, affecting the buccal mucosa.

Figure 4

Chronic cutaneous lupus erythematosus. (A) Verrucous variant, located on the upper limb. (B) Lupus panniculitis, affecting the arm and progressing to lipoatrophy.

Figure 5

(A) Lupus erythematosus tumidus: arciform and annular erythemato edematous lesions on the face and neck. (B) Bullous lupus erythematosus: bullous, hemorrhagic ulcerocrusted and hypochromic residual lesions located in the cervical region, trunk, axillae and upper limbs.