Systemic lupus erythematosus

Systemic lupus erythematosus is seen most commonly in young women of child bearing age. Its progression is usually through a series of exacerbations followed by periods of remission (Figure 13.2). Systemically it affects many organs as well as the skin, including joints, heart and pericardium, lungs, kidneys, brain and haemopoietic system. The disease is characterised by the development of cytotoxic antibodies and immune complexes (Graham- Brown and Bourke, 1998). The symptoms of SLE are outlined in Box 13.1. (Note that the first four symptoms are also present in cutaneous lupus erythematosus when systemic disease is not present (or only very mildly).

Figure 13.2 Lupus. (Source: Reprinted from Weller et al., 2008.)

Box 13.1 Clinical features of SLE Erythematous plaque on face but also on neck, ears or scalp; Follicular plugging; Scarring in the plaques which can lead to permanent hair loss when on the scalp; Mouth, nasal epithelium and conjunctiva may also be affected; Photosensitivity (more marked in SLE); Raynaud’s phenomenon; Diffuse patchy hair loss; ‘Butterfly patch’ across the face, more accurately described as a blotchy, evanescent, erythematous rash which is more widely distributed than just across nose and cheeks (Graham-Brown and Bourke, 1998); Vasculitis.

Treatment for SLE
Early treatment of plaques with potent topical steroids is important to minimise scarring. Advice about avoiding sun exposure should also be given. Otherwise, the mainstay of treatment for SLE is immunosuppressive comprising of oral steroids and/or azathioprine.