What are the cutaneous findings in acute and bullous SLE?

The cutaneous findings of acute SLE are most common on the sun-exposed areas of the skin. The eruption consists of an evanescent erythema that is especially evident over the malar area of the face, producing the characteristic “butterfly rash.” The erythema lasts hours to days and can resolve without residua. In a significant number of patients, the acute erythema can evolve into discoid lupus erythematosus, which is a chronic scaling eruption with scarring.

In bullous SLE, the patients present with tense vesicles or bullae, usually in sun-exposed sites. These are important presentations, because both may be associated with severe internal disease.