Kp 19.18 a Lupus Eritematous

8/17/2019 Kp 19.18 a Lupus Eritematous

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Lupus erythematosusLupus erythematosus

Discoid lupus erythematosusDiscoid lupus erythematosus

Systemic lupus erythematosusSystemic lupus erythematosus


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Discoid Lupus erythematosusDiscoid Lupus erythematosus

Young adultYoung adult

Women: men = 2:1Women: men = 2:1

Clinnical Findings :Clinnical Findings : Dull red macule with adherent scale withDull red macule with adherent scale with

follicular plugging, which heal with atrophy,follicular plugging, which heal with atrophy,

scarring and pigemantary changing,scarring and pigemantary changing,

telangieatasis!telangieatasis! Side: usually a"o#e the nec! Fa#orite areSide: usually a"o#e the nec! Fa#orite are

scalp, "ridges of the nose, malar areas,scalp, "ridges of the nose, malar areas,

lower lips and earslower lips and ears


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$enerali%ed dle is less common than$enerali%ed dle is less common than

locali%ed D&' and is usuallylocali%ed D&' and is usually

suerimposed on alocalli%ed discoidsuerimposed on alocalli%ed discoid

case!case! (rogression from D&' to systemic(rogression from D&' to systemic

lupus erythematosus )S&'* islupus erythematosus )S&'* is

uncommon!uncommon!


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Differential diagnosisDifferential diagnosis

+ Se"orrheic dermatitisSe"orrheic dermatitis

+ osaceaosacea

+ &upus #ulagris&upus #ulagris

+ SarcoidSarcoid

+ Drug eruptionDrug eruption


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-reatment-reatment

+ .#oid e/posure to sunlight, e/cessi#e.#oid e/posure to sunlight, e/cessi#e

cold, to heat and traumacold, to heat and trauma

+ 0se a high S(F sun screen0se a high S(F sun screen

+ &ocal:&ocal: potent or super potent corticosteroidpotent or super potent corticosteroid

ntralesional triamsinolon acetonide 2, tontralesional triamsinolon acetonide 2, to13 mg4ml13 mg4ml


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SystemicSystemic

+ .nti malarials! 5ydro/ychloro6uine 7,.nti malarials! 5ydro/ychloro6uine 7,

mg4g4day! Chloro6uine 23 mg4daymg4g4day! Chloro6uine 23 mg4day

+ 8uinacrine8uinacrine

+ Systemic corticosteroid for widespreadSystemic corticosteroid for widespread

or disfuguring lesionor disfuguring lesion


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Systemic Lupus ErythematosusSystemic Lupus Erythematosus

Young to middle aged womenYoung to middle aged women

Sin in#ol#ement occurs in 93 ofSin in#ol#ement occurs in 93 of

casescases

Diagnosis of S&' are "ased on four ofDiagnosis of S&' are "ased on four of

the .merican heumatismthe .merican heumatism

.ssosiation;s 11 criteria.ssosiation;s 11 criteria


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Cutaneus manifestationCutaneus manifestation+ uncti#itis, episcleritis, #aginal ulcercon>uncti#itis, episcleritis, #aginal ulcer

+ &eg ulcer&eg ulcer

+ Cutaneous angiitisCutaneous angiitis+ Calcinosis cutisCalcinosis cutis


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Systemic manifestationSystemic manifestation

+ .rthralgia.rthralgia

+ enal in#ol#ementenal in#ol#ement

+ yocarditisyocarditis+ C?S in#ol#ementC?S in#ol#ement

+ @asculitis@asculitis

+ Con#ulsionCon#ulsion

+ 'pilepsy'pilepsy

+ etinitisetinitis

+ diopathic trom"ocytopenic purpuradiopathic trom"ocytopenic purpura


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'tiology'tiology+ $enetic$enetic

+ .ltered immune respon.ltered immune respon

+ Drugs such as hydrala%ine, procainamid,Drugs such as hydrala%ine, procainamid,sulfonamid, penicillin, anticon#ulsan,sulfonamid, penicillin, anticon#ulsan,

minocycline and isonia%idminocycline and isonia%id


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&a"oratory findings&a"oratory findings+ .nemia hemolytic.nemia hemolytic

+ -hrom"ocytopenia-hrom"ocytopenia

+ &ymphopenia&ymphopenia

+ &euopenia&euopenia

+ 'rythrocyte sedimentation rate is'rythrocyte sedimentation rate is

ele#atedele#ated+ Coom"s tes positif Coom"s tes positif

+ geumatoid factor positif geumatoid factor positif


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mmulogic findingsmmulogic findings

+ .?. test.?. test

+ &' cell test&' cell test

+ Ds D?.Ds D?.

+ .nti S anti"ody.nti S anti"ody

+ &upus "and test&upus "and test

+ .?. pattern.?. pattern


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Differential diagnosisDifferential diagnosis

+ DermtaomyositisDermtaomyositis

+ -o/ic erytema multiforme-o/ic erytema multiforme

+ .cute rheumatoid fe#er.cute rheumatoid fe#er

+ Drug eruptionDrug eruption

+ S>ogren;s syndromeS>ogren;s syndrome


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-reatment-reatment

+ .#oid e/posure to sunlight and use a high S(F.#oid e/posure to sunlight and use a high S(F

sun screensun screen

+ .ntimalarial: hydro/ychloto6uin or chloro6uin.ntimalarial: hydro/ychloto6uin or chloro6uin+ Corticosteroid: 1333 mg of prednisolone @Corticosteroid: 1333 mg of prednisolone @

daily for A days , followed "t oraal prednisonedaily for A days , followed "t oraal prednisone

3, to 1 mg4g4dailly3, to 1 mg4g4dailly

+ mmunosuppressi#e therapy: a%athiopreine,mmunosuppressi#e therapy: a%athiopreine,methotre/ate and cyclophosphamidemethotre/ate and cyclophosphamide


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1982 ACR (Revised 1997) SLE1982 ACR (Revised 1997) SLE

Classiicatio! CriteriaClassiicatio! Criteria

1!1! alar )"utterfly* rashalar )"utterfly* rash2!2! Discoid lesionsDiscoid lesions

A!A! (hotosensiti#ity(hotosensiti#ity

B!B! ral ulcersral ulcers

!! ?ondeforming arthritis )nonerosi#e for the most part*?ondeforming arthritis )nonerosi#e for the most part*

7!7! Serositis: pleuropericarditis, aseptic peritonitisSerositis: pleuropericarditis, aseptic peritonitis

E!E! enal: persistent proteinuria 3! g4d or AG or cellularenal: persistent proteinuria 3! g4d or AG or cellularcastscasts

9!9! ?eurologic disorders: sei%ures, psychosis?eurologic disorders: sei%ures, psychosis

H!H! 5eme: hemolytic anemiaI leuopenia, throm"ocytopenia5eme: hemolytic anemiaI leuopenia, throm"ocytopenia

13!13! mmune: antiD?., or antiSm, or .(S ).C. g$, g*,mmune: antiD?., or antiSm, or .(S ).C. g$, g*,or lupus anticoagulant )standard* or false G (or lupus anticoagulant )standard* or false G (

11!11! (ositi#e F.?. )fluorescent antinuclear anti"ody*(ositi#e F.?. )fluorescent antinuclear anti"ody*


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SLE"Cli!ical a!d La#oratory $eaturesSLE"Cli!ical a!d La#oratory $eatures

usculoseletalusculoseletal H3H3 SinSin 9393 enalenal 33 C?SC?S 11

Se#ere throm"ocytopeniaSe#ere throm"ocytopenia 1313

(ositi#e .?.(ositi#e .?. HG HG

.lso, cardiopulmonary in#ol#ement,.lso, cardiopulmonary in#ol#ement,throm"otic tendency ).(S*, andthrom"otic tendency ).(S*, and JprematureK or accelerated JprematureK or acceleratedatherosclerosisLatherosclerosisL


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Moint in#ol#ement in lupus mimics rheumatoid arthritis ).* "ut milder


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Maccoud;s arthropathy


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.rthritis in lupus can "eeforming "ut is typically

nonerosi#eL


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Kp 19.18 a Lupus Eritematous

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