EDITORIAL ESPANOL:

====================

Hola amigos de la red, DERMAGIC de nuevo con ustedes,,, el tema de hoy,,, LUPUS ERITEMATOSO DISCOIDEO, patología interesante por el simple hecho, que puede permanecer como tal durante muchos años (crónico), o ser el comienzo o anuncio de otras enfermedades como el lupus sistémico. Espero que estas 61 referencias sean bastante ilustrativas.

En el attach una lámina ilustrativa del tema. Lupus discoide crónico en cara, oreja, hombro y cuero cabelludo.

PRÓXIMAS EDICIONES: * DERMATOMIOSITIS. 

* ESCLEROSIS SISTÉMICA PROGRESIVA, 

* LUPUS ERITEMATOSO SISTÉMICO.

Saludos,,,

Dr. José Lapenta R.,,,

 EDITORIAL ENGLISH:

===================

Hello friends of the net, DERMAGIC again with you, today's topic, DISCOID LUPUS ERYTHEMATOSUS, interesting pathology for the simple fact that can remain as such during many years (chronic), or to be the beginning or announcement of other illnesses like the systemic lupus. I hope these 61 references will be quite illustrative.

In the attach an illustrative sheet of the topic: Discoid lupus Erythematosus chronicus: face, ear, shoulder and scalp.

NEXT EDITIONS: * DERMATOMYOSITIS. 

* SYSTEMIC SCLEROSIS (SCLERODERMA)

* SYSTEMIC LUPUS ERYTHEMATOSUS 

Greetings,,,

Dr. José Lapenta R. 

=====================================================================

DERMAGIC/EXPRESS(52)

=====================================================================

LUPUS ERITEMATOSO DISCOIDEO / DISCOID LUPUS ERYTTHEMATOSUS

=====================================================================

===================================================================

1.) [Treatment of discoid lupus erythematosus with sulfasalazine: 11 cases] 

2.) Serologic and clinical features of patients with discoid lupus

erythematosus: relationship of antibodies to single-stranded

deoxyribonucleic acid and of other antinuclear antibody subsets to clinical

manifestations. 

3.) An unusual ocular manifestation of discoid lupus erythematosus. 

4.) Immunohistochemical detection of proliferation and differentiation in

discoid lupus erythematosus. 

5.) Squamous cell carcinoma of the skin in black patients with discoid lupus

erythematosus. 

6.) The expression of C3b receptors in the differentiation of discoid lupus

erythematosus and systemic lupus erythematosus. 

7.) [Successful treatment of chronic discoid lupus erythematosus with argon

laser] 

8.) Discoid lupus erythematosus presenting as asymmetric posterior

blepharitis. 

9.) Squamous-cell carcinoma of the scalp arising in lesions of discoid lupus

erythematosus. 

10.) Resistant discoid lupus erythematosus of palms and soles: successful

treatment with azathioprine. 

11.) Autoantibodies to evolutionarily conserved epitopes of enolase in a

patient

with discoid lupus erythematosus. 

12.) Keratin and involucrin expression in discoid lupus erythematosus and

lichen

planus. 

13.) Defective degradation of bacterial DNA by phagocytes from patients with

systemic and discoid lupus erythematosus. 

14.) [Comparative immunofluorescence study of actinic keratosis and chronic

discoid lupus erythematosus] 

15.) Vitronectin colocalizes with Ig deposits and C9 neoantigen in discoid

lupus

erythematosus and dermatitis herpetiformis, but not in bullous pemphigoid. 

16.) A comparison of the dermal lymphoid infiltrates in discoid lupus

erythematosus and Jessner's lymphocytic infiltrate of the skin using the

monoclonal antibody Leu 8. 

17.) T-cell subsets in lesions of systemic and discoid lupus erythematosus. 

18.) A comparative immunohistochemical study of lichen planus and discoid

lupus erythematosus. 

19.) Enhanced normal tissue response to radiation in a patient with discoid

lupus erythematosus. 

20.) Retinitis pigmentosa and discoid lupus erythematosus. 

21.) Discoid lupus keratitis. 

22.) Acetylator polymorphism in discoid lupus erythematosus. 

23.) Hereditary deficiency of C5 in association with discoid lupus

erythematosus. 

24.) Squamous cell carcinoma of the lip developing in discoid lupus

erythematosus. 

25.) [Oral discoid lupus erythematosus. Diagnostic considerations apropos of a

case] 

26.) Markers in cutaneous lupus erythematosus indicating systemic

involvement. A 

multicenter study on 296 patients.

27.) NAT2 genotyping and efficacy of sulfasalazine in patients with

chronic discoid 

lupus erythematosus.

28.) ARA and EADV criteria for classification of systemic lupus

erythematosus in 

patients with cutaneous lupus erythematosus.

29.) Chronic discoid lupus erythematosus in Thailand: direct

immunofluorescence study.

Kulthanan K; Roongphiboolsopit P; Chanjanakijskul S; Kullavanijaya P

30.) Chronic discoid lupus erythematosus: an immunopathological and

electron microscopic study.

31.) Squamous cell carcinoma of the lip developing in discoid lupus

erythematosus.

32.) Childhood discoid lupus erythematosus.

34.) Systemic sclerosis (scleroderma) associated with discoid lupus

erythematosus.

36.) Clinical, histologic, and immunofluorescent distinctions between

subacute cutaneous lupus erythematosus and discoid lupus erythematosus.

37.) Scarring alopecia in discoid lupus erythematosus.

39.) Chilblain lupus erythematosus: report of 15 cases [see comments]

40.) Sweat gland abnormalities in lichenoid dermatosis.

41.) The progressive systemic sclerosis/systemic lupus overlap: an unusual

clinical progression.

42.) Safety and efficacy of a broad-spectrum sunscreen in patients with

discoid or subacute cutaneous lupus erythematosus.

43.) Hereditary deficiency of C5 in association with discoid lupus

erythematosus.

44.) Response of discoid and subacute cutaneous lupus erythematosus to

recombinant interferon alpha 2a.

45.) Recombinant interferon alpha 2a is effective in the treatment of

discoid and subacute cutaneous lupus erythematosus.

46.) Experimental reproduction of skin lesions in lupus erythematosus by

UVA and UVB radiation [see comments]

47.) Histopathologic comparison of the subsets of lupus erythematosus [see

comments]

48.) Chronic cutaneous lupus erythematosus.

49.) Rowell's syndrome. Report of a case.

50.) Expression of lymphocyte activation markers in benign cutaneous T cell

infiltrates. Discoid lupus erythematosus versus lichen ruber planus.

51.) [Congenital ischemic onychodystrophy (Iso-Kikuchi syndrome) and

chronic lupus 

52.) Evaluation of lymphocyte activation in skin lesions of patients with

mixed connective tissue disease and discoid lupus erythematodes.

53.) Autofluorescence of clofazimine in discoid lupus erythematosus.

54.) A family survey of lupus erythematosus. 1. Heritability.

55.) A comparison of the dermal lymphoid infiltrates in discoid lupus

erythematosus and Jessner's lymphocytic infiltrate of the skin using the

monoclonal antibody Leu 8.

56.) Lupus profundus in children: treatment with hydroxychloroquine.

57.) The reliability of immunofluorescence and histopathology in the

diagnosis of discoid lupus erythematosus and lichen planus.

58.) Immunopathology of cutaneous human lupus erythematosus defined by

murine monoclonal antibodies.

59.) HLA genotypes in a family with a case of homozygous C2 deficiency and

discoid lupus erythematosus.

60.) Laser treatment of discoid lupus (case report).

61.) Serologic and clinical features of patients with discoid lupus

erythematosus: relationship of antibodies to single-stranded

deoxyribonucleic acid and of other antinuclear antibody subsets to clinical

manifestations.

====================================================================

====================================================================

1.) [Treatment of discoid lupus erythematosus with sulfasalazine: 11 cases] 

====================================================================

Author 

Delaporte E; Catteau b; Sabbagh N; Gosselin P; Breuillard F; Doutre MS;

Broly F; Piette F; Bergoend H 

Address 

Service de Dermatologie A, H^opital Claude-Haried, CHRU, Lille. 

Source 

Ann Dermatol Venereol, 124(2):151-6 1997 

Abstract 

INTRODUCTION: Antimalaria agents and thalidomide are two reference drugs

for discoid lupus erythematosus. In non-responders or after secondary

resistance or contraindications, there are a number of alternative

therapeutics which are less effective and more toxic. We therefore

conducted an open study in patients with discoid lupus erythematosus

treated with sulfasalazine. PATIENTS AND METHODS: Seven men and four women

(mean age 40 years) with severe discoid lupus erythematosus (mean duration

of disease 14 years) were treated with sulfasalazine (2 g/d). This

treatment was initiated after a previous failure or contraindication of

antimalarial drugs or thalidomide. The acetylation phenotype was predicted

in all patients with N-acetyltransferase 2 genotyping. Genome DNA was

tested for mutations causing an N-acetyltransferase deficiency. Homozygous

individuals or those with heterozygous composites for the tested mutations

were predicted slow acetylators and those with a homozygous or heterozygous

genotype for an allele carrying a normal sequence at the mutation sites

were predicted rapid acetylators. RESULTS: We had 7 complete responses, 1

partial response and 3 failures. Mean delay to efficacy was 7 weeks, longer

for lesions involving the scalp (4 to 5 months). Six of the 8 responders

were given sulfasalazine exclusively. The effect was suspensive and

dose-dependent; the minimal effective dose was 1.5 g/d. Excepting light

sensitization requiring discontinuation, there were no clinically

significant side effects. Neutropenia occurred in one patient and moderate

and transient live enzyme movements did not require treatment withdrawal.

The only immunoallergic side effect (light sensitization) observed occurred

in a slow acetylator. All responders except one were rapid acetylators.

DISCUSSION: Salazosulfapyridine, or sulfasalazine, is composed of a

derivative of 5-aminosalicylic acid and a sulfamide fraction,

sulfapyridine. It is only marginally used in dermatology except for

psoriasis. Its efficacy in chronic lupus erythematosus has been reported in

one case. We confirmed the role of this compound in the treatment of

chronic lupus erythematosus. The rare observations of induced lupus and

development of antinuclear antibodies are not a contraindication, but

require close regular clinical and biological surveillance. The potential

risk is that possible hypersensitivity could lead to reserving

sulfasalazine for severe resistant chronic lupus erythematosus after

failure with antimalarials and thalidomide. Nevertheless, our study

demonstrates that the slow acetylator phenotype predicts immunoallergic

events, as observed by other authors, and would be a factor predicting

nonresponse. If these results are confirmed by other studies, it would be

possible to propose sulfasalazine as a treatment for discoid lupus

erythematosus in rapid acetylators. 

=====================================================================

2.) Serologic and clinical features of patients with discoid lupus

erythematosus: relationship of antibodies to single-stranded

deoxyribonucleic acid and of other antinuclear antibody subsets to clinical

manifestations. 

=====================================================================

Author 

Callen JP; Fowler JF; Kulick KB 

Source 

J Am Acad Dermatol, 13(5 Pt 1):748-55 1985 Nov 

Abstract 

Serologic and clinical data were obtained from forty patients with discoid

lupus erythematosus in 1982. Clinical disease was characterized by quality,

extent, severity, activity, photosensitivity, and systemic manifestations.

The patient's sera were examined for the presence of antinuclear, anti-Ro

and anti-La, anti-ribonucleoprotein and anti-Sm, anti-single-stranded

deoxyribonucleic acid (ssDNA), and antinative DNA antibodies. In late 1984,

thirty-three patients had follow-up clinical examinations. On the initial

evaluation the patients with positive antinuclear antibody (ANA) findings

were clinically characterized by a significantly higher incidence of

photosensitivity and arthritis, an elevated erythrocyte sedimentation rate,

and cutaneous lesions of subacute cutaneous lupus erythematosus. The

activity and extent of disease in 1982 did not correlate with the presence

of ANA. Elevated levels of ssDNA antibodies were present in seven of the

forty patients (significantly greater than control subjects; (p less than

0.005) and correlated with widespread, active discoid lupus erythematosus,

an elevated erythrocyte sedimentation rate, and a slightly greater risk of

systemic lupus erythematosus in 1982. At the 2-year follow-up examination,

thirteen of the seventeen patients with a positive ANA had active clinical

cutaneous disease, and ten of the sixteen patients with negative ANA

findings had continued activity (not statistically significant). However,

all seven patients with elevated ssDNA antibody levels had continued

activity, and disease progression had occurred in three. Thus the presence

of ssDNA seems to correlate strongly with active, progressive lupus

erythematosus. The presence of antibody abnormalities in patients with

discoid lupus erythematosus correlates with clinical disease and provides

more support for the theory linking discoid lupus erythematosus to systemic

lupus erythematosus as part of a continuum. 

=====================================================================

3.) An unusual ocular manifestation of discoid lupus erythematosus. 

=====================================================================

Author 

Foster RE; Lowder CY; Meisler DM; Valenzuela R; McMahon JT; Camisa C 

Address 

Department of Ophthalmology, Cleveland Clinic Foundation, OH 44195. 

Source 

Cleve Clin J Med, 61(3):232-7 1994 May-Jun 

Abstract 

BACKGROUND: Discoid lupus erythematosus is a chronic skin disease

characterized by well-demarcated papules and plaques. Mucous membrane

changes are common; however, conjunctival involvement is unusual. We report

a case of unilateral, chronic, isolated discoid lupus erythematosus of the

conjunctiva. OBSERVATIONS: A 32-year-old man presented for evaluation of

chronic conjunctivitis of the right eye that had persisted for 9 years. A

biopsy of the bulbar conjunctiva revealed a mixed mononuclear cellular

infiltrate distributed along the epithelial basement membrane zone and

around the stromal blood vessels. Immunohistopathologic examination

revealed a diffuse, granular pattern of fluorescence corresponding to

immunoglobulins and complement components along the epithelial basement

membrane zone and in the walls of the stromal blood vessels. Electron

microscopy demonstrated changes in the epithelial basal lamina consistent

with discoid lupus erythematosus, including areas that were multilayered.

Immunoelectron microscopy identified sub-basal lamina deposits of

immunoglobulin G. CONCLUSIONS: Discoid lupus erythematosus should be a

suspected cause of chronic conjunctival inflammation; the diagnosis is

substantiated by immunopathologic and ultrastructural studies. 

=====================================================================

4.) Immunohistochemical detection of proliferation and differentiation in

discoid lupus erythematosus. 

=====================================================================

Author 

de Jong EM; van Erp PE; Ruiter DJ; van de Kerkhof PC 

Address 

Department of Dermatology, University Hospital Nijmegen, The Netherlands. 

Source 

J Am Acad Dermatol, 25(6 Pt 1):1032-8 1991 Dec 

Abstract 

Discoid lupus erythematosus lesions show hyperkeratosis and atrophy, which

may reflect abnormal epidermal proliferation, differentiation, or both. In

this investigation, markers for epidermal proliferation, differentiation

and inflammation were studied in cutaneous lesions of discoid lupus

erythematosus. Frozen sections of biopsy specimens from 20 patients were

examined immunohistochemically regarding Ki-67 staining and keratin 16

expression (parameters for proliferation), and the expression of keratin

10, involucrin, and filaggrin (parameters for differentiation). The

inflammatory infiltrate was characterized with the use of antibodies

against T lymphocytes, monocytes/macrophages, and Langerhans cells. With

these markers, epidermal proliferation was found to be increased in discoid

lupus erythematosus. Keratin 10 expression, a marker for early

differentiation, showed the pattern of normal skin. Involucrin and

filaggrin, markers for terminal differentiation, were expressed already in

the lower part of the stratum spinosum, whereas in normal skin these

markers were restricted to the stratum granulosum and the upper layers of

the stratum spinosum, and the stratum granulosum and stratum corneum,

respectively. Infiltrate analysis revealed the well-established picture. We

conclude that in cutaneous lesions of discoid lupus erythematosus,

hyperproliferation is combined with normal early differentiation and

premature terminal differentiation of keratinocytes. 

=====================================================================

5.) Squamous cell carcinoma of the skin in black patients with discoid lupus

erythematosus. 

=====================================================================

Author 

Caruso WR; Stewart ML; Nanda VK; Quismorio FP Jr 

Source 

J Rheumatol, 14(1):156-9 1987 Feb 

Abstract 

Skin cancer is relatively uncommon among black individuals. Squamous cell

carcinoma occurred in a scar of chronic discoid lupus erythematosus in a

black patient. A review of 7 previously reported cases of squamous cell

carcinoma in blacks with chronic discoid lupus erythematosus indicates a

tendency of the cancer to metastasize. Sun exposure of the hypopigmented

lesions of chronic discoid lupus and possibly other factors predispose to

cancer of the skin. Poorly healing skin lesions in chronic discoid lupus

should arouse suspicion of malignant change. 

=====================================================================

6.) The expression of C3b receptors in the differentiation of discoid lupus

erythematosus and systemic lupus erythematosus. 

=====================================================================

Author 

Tausk F; Harpster E; Gigli I 

Address 

Division of Dermatology, University of California, San Diego School of

Medicine. 

Source 

Arthritis Rheum, 33(6):888-92 1990 Jun 

Abstract 

We studied the expression of the C3b receptor, CR1, on erythrocytes (E-CR1)

of patients who, in spite of having mild systemic symptoms, were diagnosed

as having discoid lupus erythematosus and followed accordingly. We found

that E-CR1 was markedly reduced in these patients, similar to that seen in

patients with systemic disease. In contrast, those patients with completely

asymptomatic discoid lupus erythematosus had the same expression of E-CR1

as the normal population. 

=====================================================================

7.) [Successful treatment of chronic discoid lupus erythematosus with argon

laser] 

=====================================================================

Author 

N¨urnberg W; Algermissen B; Hermes B; Henz BM; Kolde G 

Address 

Hautklinik, Virchow-Klinikum, Humboldt-Universit¨at zu Berlin. 

Source 

Hautarzt, 47(10):767-70 1996 Oct 

Abstract 

We report on a patient with chronic discoid lupus erythematosus who was

treated with argon-laser. The patient suffered from long-standing lesions

and had been pretreated with various drugs; with no or slight improvement.

After a few argon-laser applications, the treated skin lesions improved

dramatically while the untreated lesional skin showed continuous disease

activity. Histological and immunohistological investigations of biopsies

from treated and untreated lesional skin suggest that endothelial

mechanisms play a role in the generation and maintenance of discoid lesions

in lupus erythematosus. This is the first reported case of successful

treatment of chronic discoid skin lesions of a lupus erythematosus patient

with argon-laser. 

=====================================================================

8.) Discoid lupus erythematosus presenting as asymmetric posterior

blepharitis. 

=====================================================================

Author 

Gloor P; Kim M; McNiff JM; Wolfley D 

Address 

Department of Ophthalmology and Visual Science, Yale University School of

Medicine, New Haven, CT 06520-8061, USA. peter.gloor@yale.edu 

Source 

Am J Ophthalmol, 124(5):707-9 1997 Nov 

Abstract 

PURPOSE: To describe the ophthalmic findings of patients with discoid lupus

erythematosus. METHOD: We describe two women who originally were thought to

have asymmetric posterior blepharitis; however, the involved eyelid also

had an erythematous, scaly cutaneous lesion. RESULT: In both patients,

histology and immunofluorescence studies performed on cutaneous biopsy

specimens established the diagnosis of discoid lupus erythematosus.

CONCLUSIONS: It is important to diagnose discoid lupus of the eyelids

because misdiagnosis can delay treatment and thus lead to deformities of

the eyelid margin. Misdiagnosis can also lead to a complicated

full-thickness eyelid biopsy and delay the diagnosis of systemic lupus

erythematosus. 

=====================================================================

9.) Squamous-cell carcinoma of the scalp arising in lesions of discoid lupus

erythematosus. 

=====================================================================

Author 

Sulica VI; Kao GF 

Address 

Division of Dermatology, Georgetown University Medical Center, Washington,

D.C. 

Source 

Am J Dermatopathol, 10(2):137-41 1988 Apr 

Abstract 

Squamous-cell carcinoma may arise in scars of chronic discoid lupus

erythematosus. Although there have been 19 cases reported previously,

detailed histopathologic features of this entity have not been recorded. We

report a patient with extensive chronic discoid lupus erythematosus

involving the scalp with subsequent development of multiple squamous-cell

carcinomas. The tumors were locally aggressive with recurrences and

invasion into the underlying skull and dura. The patient died of

respiratory failure 4 1/2 years after initial surgical treatment. There was

no clinical evidence of metastasis. Squamous carcinoma arising in discoid

lupus erythematosus can be regarded as a low-grade carcinoma. Although

about 20% of patients developed local recurrences and metastasis developed

in about 30%, fatality occurred in only two patients (10.5%). Pertinent

literature is reviewed, and the histopathologic findings, differential

diagnosis, and biologic behavior of this tumor are discussed. 

=====================================================================

10.) Resistant discoid lupus erythematosus of palms and soles: successful

treatment with azathioprine. 

=====================================================================

Author 

Ashinoff R; Werth VP; Franks AG Jr 

Address 

Department of Dermatology, New York University Medical Center, NY 10016. 

Source 

J Am Acad Dermatol, 19(5 Pt 2):961-5 1988 Nov 

Abstract 

We present the case of two patients with an unusual form of discoid lupus

erythematosus that was confined almost exclusively to the palms and soles.

In both patients this form of discoid lupus erythematosus did not respond

to conventional therapies, which included topical steroids, intralesional

steroids, prednisone, quinacrine hydrochloride, hydroxychloroquine sulfate,

colchicine, and dapsone. Both patients were then treated with azathioprine.

One patient dramatically improved with azathioprine, worsened each time the

azathioprine was stopped or reduced, and responded again to the

reinstitution of therapy. The other patient began taking azathioprine 8

months ago and has also experienced relief of her symptoms. These cases

suggest that discoid lupus erythematosus principally involving the palms

and soles is difficult to treat with conventional medication and that

azathioprine, which appears to be useful, should be tried after the failure

of other therapies. 

=====================================================================

11.) Autoantibodies to evolutionarily conserved epitopes of enolase in a

patient

with discoid lupus erythematosus. 

=====================================================================

Author 

Gitlits VM; Sentry JW; Matthew ML; Smith AI; Toh BH 

Address 

Department of Pathology and Immunology, Monash Medical School, Prahran,

Victoria, Australia. 

Source 

Immunology, 92(3):362-8 1997 Nov 

Abstract 

Although the pathology of discoid lupus erythematosus is well documented

the causative agents are not known. Here, we report the identity of the

target antigen of an autoantibody present in high titre in the serum of a

patient with discoid lupus erythematosus. We have demonstrated that the

antigen is enolase; first, because it has properties consistent with this

glycolytic enzyme (47,000 MW, cytosolic localization and ubiquitous tissue

distribution). Secondly, limited amino acid sequence determination after

trypsin digestion shows identity with alpha-enolase. Finally, the

autoimmune serum immunoblots rabbit and yeast enolase and predominantly one

isoelectric form of enolase (PI approximately 6.1). These results indicate

that the reactive autoepitopes are highly conserved from man to yeast. The

results also suggest that the autoantibodies are most reactive to the

alpha-isoform of enolase, although it is possible that they may also be

reactive with gamma-enolase, and have least reactivity to beta-enolase. The

anti-enolase autoantibodies belong to the immunoglobulin G1 (IgG1) isotype.

This is the first report of IgG1 autoantibodies to evolutionarily conserved

autoepitopes of enolase in the serum of a patient with discoid lupus

erythematosus. Previous reports of autoantibodies to enolase have suggested

associations with autoimmune polyglandular syndrome type I and

cancer-associated retinopathy. This report and an earlier report of what is

likely to be enolase autoantibodies in two patients without systemic

disease suggest that enolase autoantibodies have a broad association and

are not restricted to any particular disease. 

=====================================================================

12.) Keratin and involucrin expression in discoid lupus erythematosus and

lichen

planus. 

=====================================================================

Author 

Ichikawa E; Watanabe S; Takahashi H 

Address 

Division of Dermatology, Doai Memorial Hospital, Tokyo, Japan. 

Source 

Arch Dermatol Res, 289(9):519-26 1997 Aug 

Abstract 

In the present study, keratin and involucrin expression were studied in

cutaneous lesions of discoid lupus erythematosus and lichen planus in order

to gain a better understanding of the abnormal differentiation or

maturation of the epidermal cells in these dermatoses. Ten specimens each

from discoid lupus erythematosus and lichen planus were analyzed by

immunohistochemical techniques, using a panel of monoclonal antikeratin

antibodies and polyclonal anti-involucrin antibody, and five specimens each

were analyzed by one- and two-dimensional gel electrophoresis and

immunoblot analysis using three antikeratin antibodies. No significant

difference was found between the dermatoses. The expression of

differentiation-specific keratins showed a similar pattern to that in

normal epidermis, and involucrin was expressed even in the lower part of

the stratum spinosum. Keratins 6 and 16, which are characteristic markers

of hyperproliferative states, and keratin 17 were detected in

nonhyperproliferative and atrophic epidermis with hydropic degeneration and

inflammatory infiltrates in the dermis. These results suggest that

expression of keratins 6, 16 and 17 in discoid lupus erythematosus and

lichen planus may reflect a wound healing response to the damage to the

basal cell layer, or may be under the control of cytokines produced by

infiltrating inflammatory cells in the dermis. 

=====================================================================

13.) Defective degradation of bacterial DNA by phagocytes from patients with

systemic and discoid lupus erythematosus. 

=====================================================================

Author 

Roberts PJ; Isenberg DA; Segal AW 

Address 

Department of Haematology, Faculty of Clinical Sciences, University

College, London, UK. 

Source 

Clin Exp Immunol, 69(1):68-78 1987 Jul 

Abstract 

The digestion of bacterial DNA by peripheral blood monocytes was impaired

both in patients with systemic lupus erythematosus (SLE) and discoid lupus

erythematosus (DLE). The monocytes of these patients had both a small

quantitative defect in the solubilization of DNA and a marked qualitative

defect in the extent to which this DNA was degraded. In addition,

neutrophils from patients with SLE released significantly less high

molecular-weight DNA than control cells. Digestion of bacterial RNA and

protein by phagocytes was not defective in either disease. The reduced

digestion of DNA by phagocytes resulted in concomitantly larger amounts of

high molecular-weight DNA remaining in these cells. Such sequestration of

DNA may contribute to the persistence of fairly large DNA fragments in the

tissue of patients with lupus erythematosus. 

Language 

=====================================================================

14.) [Comparative immunofluorescence study of actinic keratosis and chronic

discoid lupus erythematosus] 

=====================================================================

Author 

Gruschwitz M; Keller J 

Address 

Dermatologische Universit¨ats-Klinik Erlangen. 

Source 

Z Hautkr, 62(22):1585-95 1987 Nov 15 

Abstract 

Regarding systemic (SLE) and chronic discoid lupus erythematosus (CDLE),

the diagnostic value of the lupus band test ist generally accepted. In the

literature, however, there are but few obligatory criteria concerning the

definition of a positive lupus band. In order to illustrate the influence

of sunlight on the evolution of junctional deposits of immunoglobulins, we

examplarily studied actinic keratosis (AK) as a chronic light-dependent

dermatosis. The junctional deposits in AK were qualitatively and

quantitatively compared with the lupus band typical for CDLE. In CDLE we

mostly found more distinct band-like junctional deposits of immunoglobulins

and complements. Light-dependent, non-specific junctional patterns of

immunofluorescence similar to LE, therefore, require clear morphological

criteria of immunohistology. 

=====================================================================

15.) Vitronectin colocalizes with Ig deposits and C9 neoantigen in discoid

lupus

erythematosus and dermatitis herpetiformis, but not in bullous pemphigoid. 

=====================================================================

Author 

Dahlb¨ack K; L¨ofberg H; Dahlb¨ack B 

Address 

Department of Dermatology, University of Lund, Sweden. 

Source 

Br J Dermatol, 120(6):725-33 1989 Jun 

Abstract 

C9 neoantigen immunoreactivity has been found to colocalize with C3

immunoreactivity at the dermal-epidermal junction zone (DEZ) in skin

specimens from patients with bullous pemphigoid, lupus erythematosus and

dermatitis herpetiformis. The present study was designed to elucidate

whether the C9 neoantigen immunoreactivity represents deposition of

membrane attack complexes or non-lytic SC5b-9 complexes. Skin specimens

from 11 patients with pemphigoid, five patients with discoid lupus

erythematosus and from nine patients with dermatitis herpetiformis were

studied with immunofluorescence using both monoclonal and polyclonal

antibodies against C9 neoantigen and against vitronectin (S-protein), an

inhibitor to the membrane attack complex of complement. Specimens from the

pemphigoid patients demonstrated C9 neoantigen reactivity along the DEZ

without detectable colocalized vitronectin. This suggests deposition of

membrane attack complexes in the pemphigoid lesions. Immunoreactivity of

both C9 neoantigen and vitronectin was detected in the DEZ in specimens of

discoid lupus erythematosus and in the tips of dermal papillae in specimens

of dermatitis herpetiformis. The combined presence of C9 neoantigen- and

vitronectin immunoreactivity may indicate deposition of C9 as part of the

non-lytic SC5b-9 complex. The finding reported here of differential

deposition of vitronectin and C9 in different diseases indicates that the

presence of C9 neoantigen immunoreactivity in tissue per se does not

represent the deposition of membrane attack complexes, but that it may also

be C9 deposited as part of the nonlytic SC5b-9 complex. 

=====================================================================

16.) A comparison of the dermal lymphoid infiltrates in discoid lupus

erythematosus and Jessner's lymphocytic infiltrate of the skin using the

monoclonal antibody Leu 8. 

=====================================================================

Author 

Ashworth J; Turbitt M; MacKie R 

Source 

J Cutan Pathol, 14(4):198-201 1987 Aug 

Abstract 

Jessners lymphocytic infiltration of the skin (14 cases) and discoid lupus

erythematosus (13 cases) were studied and the lymphoid infiltrates in the

dermis were compared in the two conditions, using a standard

immunoperoxidase technique. Mouse monoclonal antibodies were used to

identify T helper lymphocytes, T suppressor lymphocytes and, using the

antibody Leu 8, "immunoregulatory lymphocytes . It was shown that the

proportions of Leu 8 positive cells was significantly different in the two

conditions. The average percentage of Leu 8 positive lymphocytes in the

dermal infiltrate found in the cases of Jessner's was 65% (range 40-80%)

whereas the average percentage in the cases of discoid LE was 15% (range

2-30%). This observation is further evidence that Jessner's lymphocytic

infiltration and chronic discoid lupus erythematosus should be regarded as

separate entities. 

=====================================================================

17.) T-cell subsets in lesions of systemic and discoid lupus erythematosus. 

=====================================================================

Author 

Kohchiyama A; Oka D; Ueki H 

Source 

J Cutan Pathol, 12(6):493-9 1985 Dec 

Abstract 

In 6 patients with untreated systemic lupus erythematosus (SLE) in the

progressive stage, and in 6 with discoid lupus erythematosus (DLE), an

analysis of inflammatory infiltrates was performed in situ using the

avidin-biotin-peroxidase complex (ABC) method with monoclonal antibodies.

In all patients, over 75% of the infiltrates reacted with the pan T-cell

antibody OKT3, but only sporadically with that of B-cell OKB7. In addition,

a large number of the infiltrates were OKIal-positive, indicating that they

were in an activated state. Many OKT8-positive cells were seen infiltrating

the epidermis especially in the vicinity of basal keratinocytes. Staining

for T-cell subsets revealed that the proportion of OKT8-positive cells

(suppressor/cytotoxic) was from 2 to 3 fold higher than that of

OKT4-positive cells (helper/inducer) in lesions of SLE. On the contrary, in

DLE, a predominance of OKT4-positive cells (the OKT4/OKT8 ratio was from

1:1 to 3:1) was observed. Thus, our results provide further evidence that

these 2 main types of LE show quite contrary findings on

immunohistochemical analysis of T-cell subsets, and that besides the

humoral immune mechanism, the cell-mediated immune mechanism may be

involved in the pathogenesis of these disorders. 

=====================================================================

18.) A comparative immunohistochemical study of lichen planus and discoid

lupus erythematosus. 

=====================================================================

Author 

Lee MS; Wilkinson B; Doyle JA; Kossard S 

Address 

Skin and Cancer Foundation Australia, Darlinghurst, New South Wales,

Australia. 

Source 

Australas J Dermatol, 37(4):188-92 1996 Nov 

Abstract 

A comparative immunohistochemical study was performed on skin biopsies from

10 patients with lichen planus and 10 patients with discoid lupus

erythematosus (DLE). A panel of antibodies against T lymphocytes (UCHL-1,

OPD-4, CD8, CD43), B lymphocytes (L-26), granulocytes (Leu-M1), activation

markers (Ki-1, LN-3), macrophages, fibroblasts and dendritic cells (FXIIIa,

S-100, Mac-387, KP-1, vimentin), endothelial cells (CD34), and epithelial

cells (epithelial membrane antigen) was employed using a

peroxidase-anti-peroxidase technique. The recently released CD8 antiserum

required microwave antigen retrieval of formalin-fixed, paraffin-embedded

tissue to label lymphocytes. The results showed many similarities in the

lymphocyte subsets and macrophages between lichen planus and discoid lupus

erythematosus. The most important differences between the two conditions

were statistically significant increases in the number of S-100+ cells in

the epidermis and dermis, FXIIIa+ cells in the dermis and CD34+ vessels

within the inflammatory infiltrate in lichen planus. 

=====================================================================

19.) Enhanced normal tissue response to radiation in a patient with discoid

lupus erythematosus. 

=====================================================================

Author 

Rathmell AJ; Taylor RE 

Address 

Department of Radiotherapy and Oncology, Cookridge Hospital, Leeds, UK. 

Source 

Clin Oncol (R Coll Radiol), 4(5):331-2 1992 Sep 

Abstract 

We report the case of a patient with discoid lupus erythematosus who

developed a severe skin reaction whilst undergoing mantle irradiation for

non-Hodgkin's lymphoma. Widespread moist desquamation occurred after a skin

dose of only 17 Gy and was associated with an abscopal response outside the

treatment area. The case illustrates the need for extreme caution when

administering radiotherapy to patients with discoid or systemic lupus

erythematosus. 

=====================================================================

20.) Retinitis pigmentosa and discoid lupus erythematosus. 

=====================================================================

Author 

Desatnik H; Ashkenazi I; Regenbogen L 

Address 

Goldschleger Eye Institute, Chaim Sheba Medical Center, Sackler School of

Medicine, Tel-Hashomer, Israel. 

Source 

Metab Pediatr Syst Ophthalmol, 15(1-3):9-11 1992 

Abstract 

A 41 year old male is presented who suffers from both advanced retinitis

pigmentosa and active discoid lupus erthematosus. A possible association

between the two pigmenting disorders is discussed as well as the treatment

of the discoid lupus with potentially retinotoxic hydroxychloroquine. 

=====================================================================

21.) Discoid lupus keratitis. 

=====================================================================

Author 

Raizman MB; Baum J 

Address 

Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston

02114. 

Source 

Arch Ophthalmol, 107(4):545-7 1989 Apr 

Abstract 

Two patients with long-standing discoid lupus erythematosus developed

acute, unilateral, corneal stromal infiltration and edema. No evidence of

infection was found, and both responded rapidly to topical corticosteroid

therapy. To our knowledge, only one case of stromal keratitis associated

with discoid lupus erythematosus has been published previously. We describe

the first cases, to our knowledge, in which a satisfactory response to

corticosteroid therapy is demonstrated. 

=====================================================================

22.) Acetylator polymorphism in discoid lupus erythematosus. 

=====================================================================

Author 

Ladero JM; Jim´enez LC; Fern´andez MJ; Robledo A 

Address 

Department of Medicine, Hospital Universitario San Carlos, Facultad de

Medicina, Universidad Complutense, Madrid, Spain. 

Source 

Eur J Clin Pharmacol, 34(3):307-8 1988 

Abstract 

Acetylator phenotype was determined, using sulphamethazine, in 37 patients

with histologically confirmed discoid lupus erythematosus, who were free

from visceral damage, and in 157 normal control subjects. Twenty patients

(54%) and 90 control subjects (57.4%) were slow acetylators (p not

significant). Acetylator polymorphism appears not to be related to the risk

of developing pure cutaneous discoid lupus erythematosus. 

=====================================================================

23.) Hereditary deficiency of C5 in association with discoid lupus

erythematosus. 

=====================================================================

Author 

Asghar SS; Venneker GT; van Meegen M; Meinardi MM; Hulsmans RF; de Waal LP 

Address 

Department of Dermatology, Academic Medical Center, University of

Amsterdam, The Netherlands. 

Source 

J Am Acad Dermatol, 24(2 Pt 2):376-8 1991 Feb 

Abstract 

A 29-year-old woman with discoid lupus erythematosus had undetectable

classic pathway complement activity. Hypocomplementemia was due to

selective deficiency of C5. One of her children was also deficient. To our

knowledge this is the first documented case of an association between

discoid lupus erythematosus and C5 deficiency. 

=====================================================================

24.) Squamous cell carcinoma of the lip developing in discoid lupus

erythematosus. 

=====================================================================

Author 

Handlers JP; Abrams AM; Aberle AM; Auyong T; Melrose RJ 

Source 

Oral Surg Oral Med Oral Pathol, 60(4):382-6 1985 Oct 

Abstract 

Since the substitution of steroids and antimalarials for irradiation in the

treatment of discoid lupus erythematosus, squamous cell carcinoma arising

in discoid lupus erythematosus is thought by some to be an uncommon

occurrence. A review of the recent literature (subsequent to 1945) revealed

fifteen cases, of which seven occurred in the lips. In one of twelve of the

cases a history of irradiation was documented. In three other cases, there

was no evidence of its use. We report an additional case of squamous cell

carcinoma occurring in the lower lip of a 24-year-old black woman in the

absence of radiation therapy. A review of the literature and a discussion

of possible predisposing factors are presented. 

=====================================================================

25.) [Oral discoid lupus erythematosus. Diagnostic considerations apropos of a

case] 

=====================================================================

Author 

Bermejo Fenoll A; Rom´an Maci´a P; Bag´an Sebasti´an JV; Gonz´alez

L´opez-Briones L 

Source 

Rev Stomatol Chir Maxillofac, 86(3):156-64 1985 

Abstract 

The study and presentation of a typical case of discoid lupus erythematosus

with oral lesions in a 30-years old woman, without visceral manifestations

at present, was the motive for a revision and updating of the concepts of

etiology, differential diagnosis, treatment and prognosis of this disease.

The authors emphasize the importance of the clinical and evolving aspect of

the lesions, long-term development, as well as the response to treatment

(an antimalarial synthesis, applied systematically and infiltrates with

betamethasone solution) in order to reach valid diagnostic conclusions. It

is important in the anatomopathological study to include the atrophic zones

of the central portion of the discoid lesion. 

=====================================================================

26.) Markers in cutaneous lupus erythematosus indicating systemic

involvement. A 

multicenter study on 296 patients.

=====================================================================

Tebbe B; Mansmann U; Wollina U; Auer-Grumbach P; Licht-Mbalyohere A;

Arensmeier M; 

Orfanos CE

Department of Dermatology, University Medical Center Benjamin Franklin,

The Free 

University of Berlin, Germany.

Acta Derm Venereol (NORWAY) Jul 1997 77 (4) p305-8 ISSN: 0001-5555

Language: ENGLISH

Document Type: JOURNAL ARTICLE; MULTICENTER STUDY 

Journal Announcement: 9711

Subfile: INDEX MEDICUS

Lupus erythematosus (LE) is an autoimmune disorder, involving the skin

and/or other 

internal organs. As cutaneous variants, chronic discoid LE (CDLE) and

subacute 

cutaneous LE (SCLE) usually have a better prognosis, however, involvement

of internal 

organs with transition into systemic disease may occur. The aim of this

study was to 

assess the significance of some clinical and laboratory criteria that could

serve as 

markers for early recognition of systemic involvement in cutaneous LE.

Three hundred 

and seventy-nine patients with LE, seen in five cooperating Departments of 

Dermatology during the years 1989-1994, were documented by electronic data

processing 

according to a common protocol. Two hundred and forty-five of these

patients had 

cutaneous LE (CDLE or SCLE), and 51 had systemic LE (SLE) and were included

in this 

study. Forty-nine patients with either CDLE/SCLE or SLE were not evaluated

because 

of incomplete documentation; also, 34 patients suffered from other LE

subsets and 

were likewise excluded from the evaluation. Multivariate statistical

analysis was 

used to assess the value of seven selected variables for distinguishing

between the 

CDLE/SCLE and SLE groups: ESR, titers of antinuclear antibodies, anti-dsDNA-

antibodies, photosensitivity, presence of arthralgias, recurrent headaches

and signs 

of nephropathy. Univariate and multivariate analysis of the obtained data

showed 

that signs of nephropathy (proteinuria, hematuria) was the variable with

the highest 

statistical relevance for distinguishing between patients with cutaneous

(CDLE/SCLE) 

and with systemic LE (SLE) in all statistical models tested, followed by

the presence 

of arthralgias and of high ANA titers (> or =1:320). In contrast, low ANA

titers as 

well as anti-dsDNA antibodies showed little or no statistical relevance as a 

criterion for distinction. It seems, therefore, that cutaneous LE patients

showing 

signs of nephropathy, presence of arthralgias and elevated ANA titers (> or

=1:320) 

should be carefully monitored, because they may be at risk of developing

systemic LE 

involvement.

=====================================================================

27.) NAT2 genotyping and efficacy of sulfasalazine in patients with

chronic discoid 

lupus erythematosus.

=====================================================================

Sabbagh N; Delaporte E; Marez D; Lo-Guidice JM; Piette F; Broly F

Laboratoire de Biochimie et Biologie Moleculaire de l'hopital Calmette, 

Universitaire de Lille, France.

Pharmacogenetics (ENGLAND) Apr 1997 7 (2) p131-5 ISSN: 0960-314X

Language: ENGLISH

Document Type: JOURNAL ARTICLE 

Journal Announcement: 9710

Subfile: INDEX MEDICUS

Sulfasalazine is an effective agent for chronic discoid lupus

erythematosus (CDLE) 

but the response to treatment is considerably variable between patients and

is also 

unpredictable. The reason for this might relate to differences in

metabolism of the 

drug which is extensively acetylated by the polymorphic enzyme

N-acetyltransferase 2 

(NAT2). To test this possibility, the N-acetylation phenotype of eleven

patients 

with CDLE and treated by standard doses of sulfasalazine was retrospectively 

determined by genotyping. A clear-cut difference in the outcome of

treatment was 

observed according to whether the patients were slow acetylators (SA) or

rapid 

acetylators (RA). Eight out of 11 patients responded to treatment with a

complete or 

marked remission of the disease. Seven of them were RA. The three other

patients 

who did not respond at all to the drug were SA. In addition, SA seem to be

more 

prone to toxic events. These findings strongly suggest that the genetic

polymorphism 

of NAT2 is responsible for differences in the response to sulfasalazine in

patients 

with CDLE. Therefore, candidates for sulfasalazine therapy should be

genotyped to 

identify those patients who might benefit from the drug.

=====================================================================

28.) ARA and EADV criteria for classification of systemic lupus

erythematosus in 

patients with cutaneous lupus erythematosus.

=====================================================================

Parodi A; Rebora A

Department of Dermatology, University of Genoa, Italy.

Dermatology (SWITZERLAND) 1997 194 (3) p217-20 ISSN: 1018-8665

Language: ENGLISH

Document Type: JOURNAL ARTICLE 

Journal Announcement: 9710

Subfile: INDEX MEDICUS

OBJECTIVE: To verify (1) how many patients with cutaneous lupus

erythematosus (CLE) 

fulfill 4 or more American Rheumatism Association (ARA) and European

Academy of 

Dermatology and Venereology (EADV) criteria for classification of systemic

lupus 

erythematosus (SLE); (2) which criteria are mostly fulfilled; (3) the

severity of the 

disease in patients fulfilling criteria; (4) how many patients with systemic 

involvement fail to fulfill 4 ARA and EADV criteria. METHODS: We studied 207 

patients with chronic and subacute CLE, classified according to ARA and

EADV criteria. 

RESULTS: Twenty-four patients with localized discoid (L-DLE; 21.8%), 22 with 

disseminated discoid (D-DLE; 30.5%) and 7 with subacute CLE (SCLE; 28%) had

4 or more 

ARA criteria. With EADV criteria, these figures fell to 7 (6.4%), 7 (9.7%)

and 6 

(24%), respectively. Only 3 L-DLE (2.7%), 5 D-DLE (6.9%) and 3 SCLE cases

(12%) 

defined as SLE by ARA criteria and 1, 3 and 3, respectively, by EADV

criteria had a 

renal or neurological disorder, hemolytic anemia and/or thrombocytopenia,

vasculitis 

or serositis. ARA criteria did not classify 7 patients with a similar

visceral 

involvement, while EADV criteria failed in 11 patients. CONCLUSION: In our

patients, 

ARA criteria showed a sensitivity of 88%, a specificity of 79%, a positive

predictive 

value of 56% and a negative predictive value of 96%. EADV criteria showed a 

sensitivity of only 64%, but a specificity of 93%, a positive predictive

value of 61% 

and a negative predictive value of 94%. ARA criteria should not be used in

CLE 

patients as they are too sensitive, poorly specific and altogether

misleading. EADV 

criteria are more specific, but less sensitive.

=====================================================================

29.) Chronic discoid lupus erythematosus in Thailand: direct

immunofluorescence study.

Kulthanan K; Roongphiboolsopit P; Chanjanakijskul S; Kullavanijaya P

=====================================================================

Institute of Dermatology, Bangkok, Thailand.

Int J Dermatol (UNITED STATES) Oct 1996 35 (10) p711-4 ISSN: 0011-9059

Language: ENGLISH

Document Type: JOURNAL ARTICLE 

Journal Announcement: 9704

Subfile: INDEX MEDICUS

BACKGROUND: Studies of chronic discoid lupus erythematosus (DLE) lesions

by direct 

immunofluorescence (DIF) were heterogeneous with respect to classes of 

immunoglobulins and sites where these were deposited. Most of the studies

were done 

in the USA and European countries. MATERIALS AND METHODS: To obtain

representative 

data from Asiatic countries, we analyzed the direct immunofluorescent

abnormalities 

of 100 DLE lesions in Thai patients who were diagnosed on the basis of

clinical and 

histologic criteria. RESULTS: Granular deposits at the dermoepidermal

junction (DEJ) 

were detected in 90% of cases. The common immunoreactants at the DEJ were

IgG (63%) 

and IgM (47%). The deposits were usually combinations of various classes of 

immunoglobulins, mostly IgG (53%) and IgM (41%). Deposits of IgG and IgM

alone at 

the DEJ were observed in 12% and 8%, respectively. Deposits at colloid

bodies, 

dermal blood vessel walls, and epidermal nuclei were sometimes also seen. 

CONCLUSIONS: The DIF test of skin biopsy specimens is diagnostically

significant in 

chronic DLE. Our study in Thai patients showed that the most common

deposit was a 

combination of various classes of immunoglobulins, mostly IgG and often IgM

as well 

as C3, and occurred at the DEJ of the involved area.

=====================================================================

30.) Chronic discoid lupus erythematosus: an immunopathological and

electron microscopic study.

=====================================================================

Shahidullah M; Lee YS; Khor CJ; Ratnam KV

National Skin Centre, National University Hospital.

Ann Acad Med Singapore (SINGAPORE) Nov 1995 24 (6) p789-92 ISSN:

0304-4602

Language: ENGLISH

Document Type: JOURNAL ARTICLE 

Journal Announcement: 9704

Subfile: INDEX MEDICUS

We studied 100 cases of chronic cutaneous discoid lupus erythematosus

(DLE) to 

evaluate the diagnostic sensitivity of immunoreactant deposition and its

possible 

role in basement membrane thickening. Histopathology was diagnostic in 71%

of cases. 

Sixty-two percent (41/66) of lesions with thickened and 50% (17/34) with

normal 

basement membrane had immunoreactant deposition. Ultrastructural study of

6 cases (3 

with and 3 without immunoreactant deposition) with thickened basement

membrane all 

showed reduplication of the lamina densa. Thickening of the basement

membrane 

appears to be contributed mainly by reduplication of the lamina densa

rather than by 

immunoreactant deposition. The direct immunofluorescence (DIF) test of

lesional skin 

was positive in 58% of patients and was independent of duration of lesion,

age and 

sex. Light microscopy has greater diagnostic sensitivity in confirming DLE

lesions 

than DIF. Direct salt split skin technique did not increase DIF

sensitivity. Scalp 

lesions showed the highest frequency (83%) of immunoreactant deposition.

As C1q was 

the commonest immunoreactant found in our study, we suggest that it should be 

routinely used when DIF is employed in the evaluation of DLE. DIF is

especially 

helpful in confirming cicatricial alopecia due to DLE.

=====================================================================

31.) Squamous cell carcinoma of the lip developing in discoid lupus

erythematosus.

=====================================================================

SO - Oral Surg Oral Med Oral Pathol 1985 Oct;60(4):382-6

AU - Handlers JP; Abrams AM; Aberle AM; Auyong T; Melrose RJ

PT - JOURNAL ARTICLE

AB - Since the substitution of steroids and antimalarials for irradiation

in the treatment of discoid lupus erythematosus, squamous cell carcinoma

arising in discoid lupus erythematosus is thought by some to be an uncommon

occurrence. A review of the recent literature (subsequent to 1945) revealed

fifteen cases, of which seven occurred in the lips. In one of twelve of the

cases a history of irradiation was documented. In three other cases, there

was no evidence of its use. We report an additional case of squamous cell

carcinoma occurring in the lower lip of a 24-year-old black woman in the

absence of radiation therapy. A review of the literature and a discussion

of possible predisposing factors are presented.

=====================================================================

32.) Childhood discoid lupus erythematosus.

=====================================================================

SO - Arch Dermatol 1993 May;129(5):613-7

AU - George PM; Tunnessen WW Jr

PT - JOURNAL ARTICLE; REVIEW (15 references); REVIEW OF REPORTED CASES

AB - BACKGROUND--Discoid lupus erythematosus (DLE) is uncommon in

childhood. Less than 2% of patients with DLE develop the disease before 10

years of age. OBSERVATIONS--We present eight cases of childhood DLE with

onset before age 10 years: four black boys with cutaneous DLE, three black

girls ages 7, 2, and 6 years at onset, who developed systemic lupus

erythematosus at ages 12, 9, and 8 years, respectively, and a 10-year-old

Hispanic boy who had a systemic flare at the age of 20 years.

CONCLUSIONS--A review of the 16 published cases of childhood DLE reveals

that it is similar to its adult counterpart in its presentation and chronic

course. However, several important differences are noted: a lack of female

predominance, a low incidence of photosensitivity, and frequent progression

to systemic lupus erythematosus at an early age. A discussion of the

management of DLE in children is also presented.

=====================================================================

33.) Warts and lupus erythematosus.

=====================================================================

SO - Lupus 1993 Feb;2(1):21-3

AU - Yell JA; Burge SM

PT - JOURNAL ARTICLE

AB - The human papilloma virus is implicated in causing several diseases,

ranging from the common wart to malignancy. We describe a high prevalence

of cutaneous warts in lupus erythematosus. The presence of warts did not

correlate with the taking of immunosuppressive drugs. This observation

suggests that there is a primary immunological defect among patients with

lupus erythematosus. We found this high rate among patients with discoid as

well as systemic lupus erythematosus. We found no correlation between the

prevalence of cutaneous warts and cervical dysplasia, or malignancy.

Discoid lupus erythematosus is often considered to be a different disease

from systemic lupus erythematosus, running a more benign course. The high

prevalence of cutaneous warts in both conditions highlights yet another

similarity between these two diseases.

=====================================================================

34.) Systemic sclerosis (scleroderma) associated with discoid lupus

erythematosus.

=====================================================================

SO - Dermatology 1993;187(3):178-81

AU - Sasaki T; Nakajima H

PT - JOURNAL ARTICLE

AB - Six patients with systemic sclerosis (SS) and discoid lupus

erythematosus (DLE) were studied to determine whether such cases have some

common clinical and laboratory findings. DLE preceded SS in all cases.

Three patients had diffuse scleroderma with lung and esophagus involvements

and the others limited scleroderma. Three patients had anti-topoisomerase-I

and antiribonucleoprotein antibodies, 2 had either of them and the

remaining anticentromere antibodies. Four had DLE located on the scalp,

leading to alopecia. The other 2 had DLE on the face and extremities. No

case fulfilled criteria for systemic lupus erythematosus (SLE). The present

cases with SS and DLE, but without SLE, indicate that this type of

systemic-cutaneous collagen disease overlap does exist and may be not so rare.

=====================================================================

35.) Vitamin E and discoid lupus erythematosus.

=====================================================================

SO - Lupus 1992 Oct;1(5):303-5

AU - Yell JA; Burge S; Wojnarowska F

PT - CLINICAL TRIAL; JOURNAL ARTICLE

AB - We treated seven patients with discoid lupus erythematosus (DLE) with

Vitamin E in an oral dose of 400 mg three times per day for 12 weeks. All

other systemic and topical treatments were discontinued 1 month before

initiation of the trial. The drug was then stopped and follow-up continued

for at least another 4 weeks. No patient showed clearing of lesions. The

trial was conducted during summer, when DLE is likely to be most active.

There was no deterioration in any patient. No side effects were noted.

=====================================================================

36.) Clinical, histologic, and immunofluorescent distinctions between

subacute cutaneous lupus erythematosus and discoid lupus erythematosus.

=====================================================================

SO - J Invest Dermatol 1992 Sep;99(3):251-7

AU - David-Bajar KM; Bennion SD; De Spain JD; Golitz LE; Lee LA

PT - JOURNAL ARTICLE

AB - Subacute cutaneous lupus erythematosus (SCLE) was originally

described and distinguished from discoid lupus erythematosus (DLE) on the

basis of clinical examination of the skin, but subsequent reports have

questioned the concept of SCLE as a marker of a unique subset of LE

patients. We classified 27 lupus patients, on the basis of cutaneous exam,

as having discoid lupus skin lesions, subacute cutaneous skin lesions, or

systemic lupus erythematosus (SLE) without DLE or SCLE lesions. Clinical

features most characteristic of SCLE rather than DLE were superficial,

non-indurated, non-scarring lesions, and photosensitivity, with lack of

induration being the single most helpful finding. Histologic examination of

lesional skin showed a relatively sparse, superficial infiltrate in SCLE

and a denser, deeper infiltrate in DLE. A distinctive pattern of staining

with direct immunofluorescence, particulate epidermal IgG deposition, was

found in seven of seven SCLE patients (all anti-Ro/SSA positive) and none

of the other patients. This distinctive pattern can be reproduced

experimentally when anti-Ro/SSA autoantibodies are infused into human

skin-grafted mice. Particulate dermal-epidermal junctional staining was the

pattern seen in the patients who did not have SCLE. Clinically defining

SCLE as a superficial inflammatory form of cutaneous lupus (i.e.,

considering lesions to be DLE if they are indurated) results in a

meaningful segregation of SCLE and DLE patient groups. The epidermal IgG

deposits unique to SCLE provide independent evidence that the clinical

findings that were used to identify the patient groups actually identify

distinctive cutaneous lupus subsets. The observation that antibodies are

present in a different location in the skin in SCLE than in DLE indicates

that SCLE and DLE are likely to have different pathomechanisms.

=====================================================================

37.) Scarring alopecia in discoid lupus erythematosus.

=====================================================================

SO - Br J Dermatol 1992 Apr;126(4):307-14

AU - Wilson CL; Burge SM; Dean D; Dawber RP

PT - JOURNAL ARTICLE

AB - The clinicopathological features of the scarring alopecia of discoid

lupus erythematosus (DLE) were studied. Scarring alopecia was present in

34% of 89 patients with DLE and was associated with a prolonged disease

course. More than half these patients had scalp involvement at the onset of

the disease. There was a significant reduction in size of sebaceous glands

in affected scalp. Perifollicular lymphocytic inflammation was maximal

around the mid-follicle at the level of the sebaceous gland, which seems to

be an important functional level in the follicle. There are changes in the

expression of the matrix molecules, the proteoglycans, in the connective

tissue sheath and the keratin intermediate filaments in the outer root

sheath cells at this level in normal scalp and in diseased scalp. Loss of a

population of mid-follicular stem cells may be important in the

pathogenesis of scarring alopecia in DLE.

=====================================================================

38.) Cutaneous lupus erythematosus in India: immunofluorescence profile

[see comments]

=====================================================================

CM - Comment in: Int J Dermatol 1993 Jan; 32(1):76

SO - Int J Dermatol 1992 Apr;31(4):265-9

AU - George R; Mathai R; Kurian S

PT - JOURNAL ARTICLE

AB - The clinical profile and cutaneous lesions of 65 patients with lupus

erythematosus (LE) are described. This included 28 discoid LE (13

disseminated, 15 localized), five subacute cutaneous LE, and 32 systemic

LE. The need to recognize a pigmented macular form constituting 25% of

discoid LE is emphasized. Increased incidence of involvement of the lower

lip in discoid LE and pigmentation in systemic LE is noted. Lupus band test

was found to be highly sensitive; it was positive for lesional skin of all

untreated patients with subacute cutaneous LE and systemic LE, it was,

however, not useful on nonlesional skin.

=====================================================================

39.) Chilblain lupus erythematosus: report of 15 cases [see comments]

=====================================================================

CM - Comment in: Dermatology 1992; 185(2):160

SO - Dermatology 1992;184(1):26-8

AU - Doutre MS; Beylot C; Beylot J; Pompougnac E; Royer P

PT - JOURNAL ARTICLE

AB - In this retrospective study, the authors describe the clinical,

histologic and laboratory features of 15 cases of chilblain or perniotic

lupus. In winter, the patients (14 women, 1 man) develop chilblain-like

lesions, chiefly in the toes (8 times) and fingers (11 times). Histologic

features are identical to those of discoid lupus erythematosus. The damaged

skin gives a positive fluorescent band test. Usually, these lesions occur

in association with discoid lupus of the face. However, in 8 patients, they

were the only cutaneous sign of lupus. This form of lupus can evolve to a

systemic form, as was the case with 3 patients.

=====================================================================

40.) Sweat gland abnormalities in lichenoid dermatosis.

=====================================================================

SO - Histopathology 1991 Oct;19(4):345-9

AU - Akosa AB; Lampert IA

PT - JOURNAL ARTICLE

AB - Lichenoid dermatosis is a pattern description of a variety of

cutaneous lesions which primarily affect the dermoepidermal junction.

Involvement of skin appendages has been restricted to hair follicles in

lichen planopilaris and discoid lupus erythematosus. Sweat gland

involvement has not been described in the four common members of this

group, namely, lichen planus, discoid lupus erythematosus, fixed drug

eruptions and erythema multiforme, although structural abnormalities have

been reported in graft-versus-host disease. In a detailed morphological

study of 59 cases, including lichen planus (12), discoid lupus

erythematosus (18), fixed drug eruption (14) and erythema multiforme (15),

78% (47/59) showed sweat, gland abnormalities. The abnormalities included

vacuolation of cell cytoplasm, with and without lymphocytic infiltration,

apoptosis of basal cells and basal cell hyperplasia of the excretory ducts

which predominantly affected the portion of the duct adjoining the

acrosyringium. The portion of the duct close to the secretory gland was

only involved in continuity and the secretory glands were unaffected. These

abnormalities of the sweat gland mostly constitute primary involvement by

the disease process in contrast to structural abnormalities secondary to

fibrosis.

=====================================================================

41.) The progressive systemic sclerosis/systemic lupus overlap: an unusual

clinical progression.

=====================================================================

SO - Ann Rheum Dis 1991 May;50(5):323-7

AU - Asherson RA; Angus H; Mathews JA; Meyers O; Hughes GR

PT - JOURNAL ARTICLE

AB - Three patients with the unusual combinations of discoid lupus,

systemic lupus erythematosus (SLE), and progressive systemic sclerosis

(PSS) are reported. The first patient developed PSS eight years after a

diagnosis of discoid lupus had been made and this was complicated by

myositis six years later. The second patient developed PSS more than 20

years after being diagnosed as having SLE. The third patient developed SLE

with predominant features of urticarial vasculitis six years after PSS.

Mild myositis also ensued. There were no antibodies to U1RNP demonstrable

in any of these patients. The clinical progression of SLE to PSS or vice

versa in the absence of features of mixed connective tissue disease is

distinctly uncommon.

=====================================================================

42.) Safety and efficacy of a broad-spectrum sunscreen in patients with

discoid or subacute cutaneous lupus erythematosus.

=====================================================================

SO - Cutis 1991 Feb;47(2):130-2, 135-6

AU - Callen JP; Roth DE; McGrath C; Dromgoole SH

PT - JOURNAL ARTICLE

AB - An eight-week, open-label study was conducted to test the efficacy,

safety, and cosmetic acceptability of a broad-spectrum sunscreen in

patients with discoid lupus erythematosus or subacute cutaneous lupus

erythematosus. The sunscreen combined the ultraviolet A absorber avobenzone

(Parsol 1789, Givaudan Corp) and the ultraviolet B absorber padimate O and

had a sun protection factor greater than fifteen. The overall clinical

disease severity decreased from 2.7 (four point scale) at baseline to 1.7

after eight weeks (p = 0.005). Cutaneous signs and symptoms, including

hyperpigmentation, papules, scaling, and erythema, were significantly less

severe at the end of the study. The level of protection provided by the

sunscreen was good to excellent in 54 percent of patients, and was judged

to be superior or far superior to previously used sun protection

factor-fifteen sunscreens in 77 percent of patients. Most patients found

the sunscreen highly acceptable with respect to its cosmetic properties.

=====================================================================

43.) Hereditary deficiency of C5 in association with discoid lupus

erythematosus.

=====================================================================

SO - J Am Acad Dermatol 1991 Feb;24(2 Pt 2):376-8

AU - Asghar SS; Venneker GT; van Meegen M; Meinardi MM; Hulsmans RF; de

Waal LP

PT - JOURNAL ARTICLE

AB - A 29-year-old woman with discoid lupus erythematosus had undetectable

classic pathway complement activity. Hypocomplementemia was due to

selective deficiency of C5. One of her children was also deficient. To our

knowledge this is the first documented case of an association between

discoid lupus erythematosus and C5 deficiency.

=====================================================================

44.) Response of discoid and subacute cutaneous lupus erythematosus to

recombinant interferon alpha 2a.

=====================================================================

SO - J Invest Dermatol 1990 Dec;95(6 Suppl):142S-145S

AU - Nicolas JF; Thivolet J; Kanitakis J; Lyonnet S

PT - JOURNAL ARTICLE

AB - Ten patients suffering from discoid lupus erythematosus (DLE) or

subacute cutaneous lupus erythematosus (SCLE) were treated with interferon

alpha 2a. A marked improvement or clearing of cutaneous lupus erythematosus

lesions was observed in eight of them. However, the response to interferon

was of short duration and within a few weeks after interferon withdrawal

all patients who were improved or cleared relapsed. This study suggests

that interferon alpha 2a represents a new interesting approach in the

treatment of DLE and SCLE. Ongoing trials will define the optimal treatment

schedule for the maintenance of interferon-induced improvement of cutaneous

lupus erythematosus.

=====================================================================

45.) Recombinant interferon alpha 2a is effective in the treatment of

discoid and subacute cutaneous lupus erythematosus.

=====================================================================

SO - Br J Dermatol 1990 Mar;122(3):405-9

AU - Thivolet J; Nicolas JF; Kanitakis J; Lyonnet S; Chouvet B

PT - CLINICAL TRIAL; JOURNAL ARTICLE

AB - Ten patients suffering from either discoid lupus erythematosus (DLE)

or subacute cutaneous lupus erythematosus (SCLE) were treated with

interferon alpha 2a. Eight received low or intermediate doses (18-45 x

10(6) U/week) for a short period of time (4-8 weeks), with marked

improvement of skin lesions in six, an exacerbation in one patient and no

change in the other. Two patients with SCLE received high doses (100-120 x

10(6) U/week) over 12 weeks, with complete clearing of the lesions in one

and a marked improvement in the other. The responses were of short duration

and within a few weeks of stopping treatment all who had improved or

cleared relapsed. The side-effects in all the patients were fever and a

flu-like syndrome which necessitated a reduction of the dose in one case.

In two patients there were increases in the liver enzyme levels, but no

haematological toxicity was noted.

=====================================================================

46.) Experimental reproduction of skin lesions in lupus erythematosus by

UVA and UVB radiation [see comments]

=====================================================================

CM - Comment in: J Am Acad Dermatol 1991 Mar; 24(3):515

SO - J Am Acad Dermatol 1990 Feb;22(2 Pt 1):181-7

AU - Lehmann P; Holzle E; Kind P; Goerz G; Plewig G

PT - JOURNAL ARTICLE

AB - Sunlight is a well-established factor in the induction and

exacerbation of lupus erythematosus. Although experimental reproduction of

lupus erythematosus lesions with wavelengths shorter than 320 nm was

demonstrated previously, the effect of wavelengths longer than 320 nm was

not investigated adequately. In this study we show that the action spectrum

of lupus erythematosus reaches into the UVA region. A total of 128 patients

with lupus erythematosus underwent phototesting with the use of

polychromatic UVB and long-wave UVA. Subsets of the disease consisted of

discoid lupus erythematosus (n = 86), subacute cutaneous lupus

erythematosus (n = 22), and systemic lupus erythematosus (n = 20). Skin

lesions clinically and histologically compatible with lupus erythematosus

were induced in 64% of patients with subacute cutaneous lupus

erythematosus, 42% of patients with discoid lupus erythematosus, and 25% of

patients with systemic lupus erythematosus. The action spectrum of the

induced lesions was within the UVB range in 33% of patients, in the UVA

range in 14%, and in the UVB and UVA range in 53%. In positive test

reactions patchy dark erythema and urticarial plaques developed within a

few days. In some patients typical discoid lesions persisted for months.

=====================================================================

47.) Histopathologic comparison of the subsets of lupus erythematosus [see

comments]

=====================================================================

CM - Comment in: Arch Dermatol 1990 Dec; 126(12):1651

SO - Arch Dermatol 1990 Jan;126(1):52-5

AU - Jerdan MS; Hood AF; Moore GW; Callen JP

PT - JOURNAL ARTICLE

AB - A recent study by Bangert et al suggests that there are quantitative

histologic differences that distinguish discoid lupus erythematosus (DLE)

and subacute cutaneous lupus erythematosus (SCLE). Utilizing criteria

proposed by these authors, we examined 77 biopsy specimens from 63 patients

with various forms of lupus erythematosus, but we were unable to predict

the correct clinical subset. Using the clinical diagnosis of DLE as a

positive reference standard, the sensitivity and specificity for the

overall pathologic diagnosis of DLE were 55% and 42%, respectively.

Statistically significant histologic factors favoring the diagnosis of DLE

over SCLE in the present study were pilosebaceous atrophy, hyperkeratosis,

parakeratosis, basement membrane thickening around the follicles,

subepidermal edema, and vascular ectasia. These histologic variables were

entered into a forward stepwise multivariate regression analysis to

determine distinct predictors of DLE vs SCLE. This analysis showed that

pilosebaceous atrophy was the only distinct significant predictor of DLE vs

SCLE. These results suggest that the histologic differentiation of

clinically defined DLE and SCLE cannot be established from the histologic

features examined.

=====================================================================

48.) Chronic cutaneous lupus erythematosus.

=====================================================================

SO - Med Clin North Am 1989 Sep;73(5):1055-71

AU - Hymes SR; Jordon RE

PT - JOURNAL ARTICLE; REVIEW (60 references); REVIEW, TUTORIAL

AB - Chronic cutaneous LE is a diverse disease, characterized by

predominantly cutaneous disease with few systemic complications. Discoid

lesions are commonly seen, but they are not specific for chronic cutaneous

LE. These scarring and disfiguring changes are also present in neonatal LE,

SLE, and complement deficiency LE. Because definitive diagnosis cannot be

made by cutaneous examination alone, all patients should initially be

evaluated for systemic disease. A small percentage of patients with chronic

cutaneous LE will ultimately develop SLE, and therefore, patients should be

re-evaluated periodically. The pathogenesis of the cutaneous lesions is not

definitively known. There is suggestive evidence implicating T-cell

mediated injury, especially in discoid LE. Antibody-dependent cellular

cytotoxicity may also play a significant role in cellular damage in

subacute cutaneous LE and neonatal LE, especially in the presence of

anti-Ro antibody. Immunoglobulin deposition in association with membrane

attack complex, has been associated with epidermal injury in some cases.

Treatment of chronic cutaneous LE is largely symptomatic and nonspecific,

focusing on reduction of inflammation. Further knowledge of pathogenesis

will, hopefully, provide for specific immunologic therapy.

=====================================================================

49.) Rowell's syndrome. Report of a case.

=====================================================================

SO - J Am Acad Dermatol 1989 Aug;21(2 Pt 2):374-7

AU - Parodi A; Drago EF; Varaldo G; Rebora A

PT - JOURNAL ARTICLE; REVIEW (8 references); REVIEW, TUTORIAL

AB - We describe a patient with discoid lupus erythematosus who developed

annular lesions of the thigh and chilblainlike lesions of the fingers

matching those described in the original reports of Rowell's syndrome. The

patient also had circulating anti-Ro(SS-A) antibodies whose similarity to

the anti-Sj-T antibodies found in the original Rowell's syndrome cases has

been recently claimed. A review of the literature suggests that most of the

cases of Rowell's syndrome described thus far in fact may be cases of

coincidental association of lupus erythematosus and erythema multiforme.

=====================================================================

50.) Expression of lymphocyte activation markers in benign cutaneous T cell

infiltrates. Discoid lupus erythematosus versus lichen ruber planus.

=====================================================================

SO - Acta Derm Venereol 1989;69(4):292-5

AU - Sundqvist KG; Wanger L

PT - JOURNAL ARTICLE

AB - The expression of lymphocyte activation markers (IL2 receptors,

transferrin receptors and HLA-DR) was examined in cutaneous lymphoid

infiltrates of 12 patients with lichen ruber planus (LP) and 10 individuals

with discoid lupus erythematosus (DLE). The cell infiltrates in both

conditions were generally of considerable size. The vast majority of the

infiltrating cells were T cells. The reactivity of the anti-IL2 receptor

antibody used was confined to lymphocytes. In patients with LP 26 +/- 17%

of the infiltrating cells were IL2 receptor positive, 20 +/- 8% carried

transferrin receptors and greater than 90% HLA-DR. In patients with DLE

less than 1% were IL2 receptor positive, less than 5% carried transferrin

receptors and greater than 90% were HLA-DR positive. These data indicate

that IL2 receptor expression distinguishes the infiltrating T-lymphocytes

in LP and DLE, although in both conditions the vast majority of the

infiltrating cells were activated as revealed by their expression of HLA-DR.

=====================================================================

51.) [Congenital ischemic onychodystrophy (Iso-Kikuchi syndrome) and

chronic lupus

=====================================================================

erythematosus]

SO - Hautarzt 1988 Nov;39(11):750-2

AU - Bittar EQ; Parra CA; Ledesma de Prieto G; Briggs E; Ortiz Baeza O

PT - JOURNAL ARTICLE

AB - We report a patient with nail and bone disorders of the index and

middle fingers (Iso and Kikuchi syndrome) associated with chronic discoid

lupus erythematosus. Angiographic studies showed filiform arteries of the

fingers and slow blood circulation. Since a vascular pathogenic mechanisms

is probable, the designation "Congenital ischemic onychodystrophy" seems

more suitable. The association with chronic discoid lupus erythematosus has

not previously been reported.

=====================================================================

52.) Evaluation of lymphocyte activation in skin lesions of patients with

mixed connective tissue disease and discoid lupus erythematodes.

=====================================================================

SO - Arch Dermatol Res 1988;280(1):1-4

AU - Bergroth V; Konttinen YT; Piirainen H; Johansson E; Nordstrom D;

Malmstrom M

PT - JOURNAL ARTICLE

AB - Biopsy specimens from mixed connective tissue disease (MCTD) and

discoid lupus erythematodes (DLE) skin lesions were stained with monoclonal

antibodies to differentiation and activation antigens. In addition, the

blast cells were studied by combining autoradiography with immunoperoxidase

staining. In both disease conditions most of the inflammatory cells in situ

were positive for T11 antigen, the CD4/CD8 ratio being low. Only a few of

the cells were pan-B positive B cells. The expression of various activation

antigens did not differ significantly between MCTD and DLE biopsy

specimens; the number of T9, Tac, and 4F2 antigen carrying cells was

relatively low, whereas Ia-positive cells were more numerous. 3H-Thymidine

incorporating T blasts comprised less than 1% of all inflammatory cells. T4

and T8 marker-carrying blast cells were present in about equal proportions.

These findings suggest that Ia antigen-expressing T cells are important

from the pathogenetic point of view in both MCTD and DLE. Because the local

proliferation of T cells was extremely low according to the lack of

interleukin-2 receptor and OKT9 markers and 3H-thymidine incorporation, it

seems probable that most of the T cells are recruited from the circulation

to the site of the inflammation.

=====================================================================

53.) Autofluorescence of clofazimine in discoid lupus erythematosus.

=====================================================================

SO - J Am Acad Dermatol 1987 Nov;17(5 Pt 2):867-71

AU - Kossard S; Doherty E; McColl I; Ryman W

PT - JOURNAL ARTICLE

AB - A 70-year-old woman developed dark reddish blue pigmentation in

scarred areas of discoid lupus erythematosus after taking clofazimine

intermittently over a period of 10 years. Although light microscopy of

routinely processed tissue failed to define the cause of the pigment,

fluorescent microscopy showed vivid red deposits concentrated around larger

vessels within the dermis. These deposits were shown to correspond to

birefringent red clofazimine crystals on fresh frozen sections. Although

the hyperpigmentation may clinically resemble melanin, biopsy specimens

from our patient revealed a loss of melanin pigment in lesional skin,

suggesting a primary role for clofazimine in producing the color changes

observed.

=====================================================================

54.) A family survey of lupus erythematosus. 1. Heritability.

=====================================================================

SO - J Rheumatol 1987 Oct;14(5):913-21

AU - Lawrence JS; Martins CL; Drake GL

PT - JOURNAL ARTICLE

AB - First degree relatives and spouses of 36 patients with systemic lupus

erythematosus (SLE) and 37 with discoid lupus erythematosus (LE) were

assessed using the ARA criteria. They were compared with relatives and

spouses of patients with other rheumatic and related complaints. Definite

SLE was present in 3.9% of relatives of SLE probands, 2.6% of discoid

relatives and 0.3% of controls. Discoid LE was diagnosed in 0.6% of SLE and

3.5% of discoid families compared with 0.5% of controls. None of the

spouses of LE probands had SLE or discoid LE. The data gave the best fit

for a polygenic inheritance with a heritability of 66 +/- 11% for SLE and

44 +/- 10% for discoid LE. Genetic factors are thus less important in SLE

and discoid LE than in generalized osteoarthritis, spondylitis or gout with

heritabilities of 90, 72 and 90%, respectively.

=====================================================================

56.) A comparison of the dermal lymphoid infiltrates in discoid lupus

erythematosus and Jessner's lymphocytic infiltrate of the skin using the

monoclonal antibody Leu 8.

=====================================================================

SO - J Cutan Pathol 1987 Aug;14(4):198-201

AU - Ashworth J; Turbitt M; MacKie R

PT - JOURNAL ARTICLE

AB - Jessners lymphocytic infiltration of the skin (14 cases) and discoid

lupus erythematosus (13 cases) were studied and the lymphoid infiltrates in

the dermis were compared in the two conditions, using a standard

immunoperoxidase technique. Mouse monoclonal antibodies were used to

identify T helper lymphocytes, T suppressor lymphocytes and, using the

antibody Leu 8, "immunoregulatory lymphocytes". It was shown that the

proportions of Leu 8 positive cells was significantly different in the two

conditions. The average percentage of Leu 8 positive lymphocytes in the

dermal infiltrate found in the cases of Jessner's was 65% (range 40-80%)

whereas the average percentage in the cases of discoid LE was 15% (range

2-30%). This observation is further evidence that Jessner's lymphocytic

infiltration and chronic discoid lupus erythematosus should be regarded as

separate entities.

=====================================================================

57.) Lupus profundus in children: treatment with hydroxychloroquine.

=====================================================================

SO - J Am Acad Dermatol 1987 Apr;16(4):839-44

AU - Fox JN; Klapman MH; Rowe L

PT - JOURNAL ARTICLE

AB - Discoid lupus erythematosus and lupus profundus, rare in children,

are described in two young girls, one with onset at 3 1/2 years of age, the

other at 8 years of age. Unusual nodules of the face that ultimately healed

with atrophy and hyperpigmentation showed histologic and immunofluorescent

confirmation of lupus erythematosus. These patients, the second and third

in the English literature to be treated for childhood lupus profundus with

antimalarials, responded successfully to hydroxychloroquine. No systemic

involvement was found.

=====================================================================

58.) The reliability of immunofluorescence and histopathology in the

diagnosis of discoid lupus erythematosus and lichen planus.

=====================================================================

SO - Br J Dermatol 1987 Feb;116(2):189-98

AU - Nieboer C

PT - JOURNAL ARTICLE

AB - We have investigated the diagnostic reliability of the

immunofluorescence (IF) technique and histopathology in discoid lupus

erythematosus (DLE) and lichen planus (LP) and in diseases clinically

resembling these (DLE-like and LP-like). In all cases of DLE and LP it was

possible to establish the clinical diagnosis with one or both methods, when

in initially negative cases the investigations were repeated on fresh

biopsies. In DLE the diagnostic specificity of IF was greater than that of

histopathology, and the diagnostic sensitivity of the results of both

methods together was greater than that of the two methods separately. In LP

the diagnostic specificity of both methods was maximal, but IF showed

greater diagnostic sensitivity. These differences were not statistically

significant. The most important immunohistochemical feature for diagnosis

by IF was the incidence and the morphological pattern of IgG along the

epidermal basement membrane. This held true for differentiation between LP

and DLE and also between DLE and DLE-like diseases. Combination of the

results of IF and histopathology gave the most reliable results in DLE. In

LP, IF was more reliable than histopathology.

=====================================================================

59.) Immunopathology of cutaneous human lupus erythematosus defined by

murine monoclonal antibodies.

=====================================================================

SO - J Am Acad Dermatol 1986 Sep;15(3):474-81

AU - Andrews BS; Schenk A; Barr R; Friou G; Mirick G; Ross P

PT - JOURNAL ARTICLE

AB - Skin biopsy specimens obtained from involved skin from sixteen

patients with systemic and discoid lupus erythematosus were studied. Murine

monoclonal antibodies with a biotin-avidin-horseradish peroxidase staining

system were used. The findings consisted of a marked reduction in the

number of epidermal Langerhans cells defined by surface antigens, reduced

HLA-DR (Ia-like) antigens on the surface of dermal capillary endothelium,

and mononuclear cell infiltrates characterized by a predominance of helper

T lymphocytes and an increase in the number of mononuclear phagocytic

cells. B lymphocytes were rarely identified. The number of T lymphocytes

within the dermis correlated inversely with both the number of

HLA-DR-positive epidermal Langerhans cells (p less than 0.01) and the

HLA-DR staining of dermal capillary endothelium (p less than 0.01). These

findings suggest that a T lymphocyte-mediated immune response associated

with a reduction in Langerhans cells and capillary endothelium HLA-DR

antigens is involved in the inflammatory process of lupus erythematosus skin.

=====================================================================

60.) HLA genotypes in a family with a case of homozygous C2 deficiency and

discoid lupus erythematosus.

=====================================================================

SO - Acta Derm Venereol 1986;66(5):419-22

AU - Braathen LR; Bratlie A; Teisberg P

PT - JOURNAL ARTICLE

AB - A fifty-year-old man with a history of recurrent bronchial and renal

infections, and rheumatoid arthritis was admitted with a

sunexposure-induced discoid lupus erythematosus. Complement levels and HLA

typing of the patient and his family revealed a homozygous C2 deficiency in

the patient and his HLA-identical healthy younger sister. The C2 deficiency

gene was associated with HLA-A10, B18, DR2, C4A4B2, BfS on one chromosome

and with HLA-A2, B7, DR2, C4A4B2, BfS on the other.

=====================================================================

61.) Laser treatment of discoid lupus (case report).

=====================================================================

SO - Lasers Surg Med 1986;6(1):12-5, 44-5

AU - Henderson DL; Odom JC

PT - JOURNAL ARTICLE

AB - This is a case report of vaporization of the characteristic

disfiguring plaques of discoid lupus erythematosus (DLE) with the carbon

dioxide laser. This patient had a dramatic clinical and cosmetic

improvement. It is suggested that the altered but not vaporized cells that

remained were responsible for the retardation of the disease process.

=====================================================================

62.) Serologic and clinical features of patients with discoid lupus

erythematosus: relationship of antibodies to single-stranded

deoxyribonucleic acid and of other antinuclear antibody subsets to clinical

manifestations.

=====================================================================

SO - J Am Acad Dermatol 1985 Nov;13(5 Pt 1):748-55

AU - Callen JP; Fowler JF; Kulick KB

PT - JOURNAL ARTICLE

AB - Serologic and clinical data were obtained from forty patients with

discoid lupus erythematosus in 1982. Clinical disease was characterized by

quality, extent, severity, activity, photosensitivity, and systemic

manifestations. The patient's sera were examined for the presence of

antinuclear, anti-Ro and anti-La, anti-ribonucleoprotein and anti-Sm,

anti-single-stranded deoxyribonucleic acid (ssDNA), and antinative DNA

antibodies. In late 1984, thirty-three patients had follow-up clinical

examinations. On the initial evaluation the patients with positive

antinuclear antibody (ANA) findings were clinically characterized by a

significantly higher incidence of photosensitivity and arthritis, an

elevated erythrocyte sedimentation rate, and cutaneous lesions of subacute

cutaneous lupus erythematosus. The activity and extent of disease in 1982

did not correlate with the presence of ANA. Elevated levels of ssDNA

antibodies were present in seven of the forty patients (significantly

greater than control subjects; (p less than 0.005) and correlated with

widespread, active discoid lupus erythematosus, an elevated erythrocyte

sedimentation rate, and a slightly greater risk of systemic lupus

erythematosus in 1982. At the 2-year follow-up examination, thirteen of the

seventeen patients with a positive ANA had active clinical cutaneous

disease, and ten of the sixteen patients with negative ANA findings had

continued activity (not statistically significant). However, all seven

patients with elevated ssDNA antibody levels had continued activity, and

disease progression had occurred in three. Thus the presence of ssDNA seems

to correlate strongly with active, progressive lupus erythematosus. The

presence of antibody abnormalities in patients with discoid lupus

erythematosus correlates with clinical disease and provides more support

for the theory linking discoid lupus erythematosus to systemic lupus

erythematosus as part of a continuum.

=====================================================================

63.) Squamous cell carcinoma of the lip developing in discoid lupus

erythematosus.

=====================================================================

SO - Oral Surg Oral Med Oral Pathol 1985 Oct;60(4):382-6

AU - Handlers JP; Abrams AM; Aberle AM; Auyong T; Melrose RJ

PT - JOURNAL ARTICLE

AB - Since the substitution of steroids and antimalarials for irradiation

in the treatment of discoid lupus erythematosus, squamous cell carcinoma

arising in discoid lupus erythematosus is thought by some to be an uncommon

occurrence. A review of the recent literature (subsequent to 1945) revealed

fifteen cases, of which seven occurred in the lips. In one of twelve of the

cases a history of irradiation was documented. In three other cases, there

was no evidence of its use. We report an additional case of squamous cell

carcinoma occurring in the lower lip of a 24-year-old black woman in the

absence of radiation therapy. A review of the literature and a discussion

of possible predisposing factors are presented.

======================================================================

DATA-MÉDICOS/DERMAGIC-EXPRESS No (52) 05/05/99 DR. JOSE LAPENTA R. 

======================================================================

Produced by Dr. José Lapenta R. Dermatologist
Venezuela 1.998-2.024

Producido por Dr. José Lapenta R. Dermatólogo Venezuela 1.998-2.0024

Tlf: 0414-2976087 - 04127766810