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Lupus

Clinical Cases

Case 1

  • 31-year-old woman with recurrent lesions on cheeks and scalp
  • Negative workup for systemic lupus erythematosus (recent)
  • Lesions are itchy, exacerbated by sun exposure
  • No current treatment

Initial evaluation

  • Diagnosis: Discoid lupus (confirmed by biopsy)
  • Desonide 0.05% ointment b.i.d. (face)
  • Clobetasol 0.05% ointment b.i.d. (scalp)
  • Counseling on photoprotection and sun avoidance
  • Vitamin D supplementation is recommended

4-week follow-up evaluation

  • Clinically improved
  • Ongoing photoprotection emphasized
  • Annual follow-up for clinical evaluation, medication refill, and screening for systemic lupus erythematosus

Case 2

  • 20-year-old woman with slightly pruritic annular, violaceous plaques for two months on back, chest, abdomen, and arms
  • No current medications
  • Negative workup for systemic lupus erythematosus (recent)

Initial evaluation

  • Diagnosis: Subacute cutaneous lupus (confirmed by skin biopsy)
  • Fluocinonide 0.05% ointment b.i.d.
  • Counseling on photoprotection and sun avoidance
  • Vitamin D supplementation is recommended

4-week follow-up evaluation

  • No clinical improvement
  • Patient is referred for ophthalmologic evaluation and started on hydroxychloroquine 5 mg/kg/day
  • Ongoing photoprotection emphasized
  • Follow-up in 6 weeks

6 weeks later

  • Patient is noting clinical improvement
  • Quarterly follow-up for clinical evaluation, medication refill, screening for systemic lupus erythematosus, and ophthalmology exam

Case 3

  • Female newborn infant born at 37 weeks gestational age
  • Presents with neonatal-onset annular violaceous scaly plaques on the face, scalp, and trunk
  • Bilateral periocular lesions (raccoon eyes)
  • Anti-Ro/SSA+ (mother is also anti-Ro+), Anti-La/SSB+
  • ANA+ (speckled pattern)
  • Diagnosis: Neonatal cutaneous lupus (confirmed by skin biopsy)

Initial evaluation

  • Electrocardiogram, transthoracic echocardiogram recommended
  • Lab studies recommended: liver transaminases, bilirubin, alkaline phosphatase, renal function, complete blood count
  • Low potency topical corticosteroid (desonide 0.05% ointment) b.i.d. recommended

1-week follow-up

  • Cardiac studies are normal
  • All lab studies are normal
  • No systemic immunosuppression or cardiac medications are indicated
  • Skin lesions are improving
  • Continue topical corticosteroids

1-month follow-up

  • Repeat lab studies are normal
  • Lesions are fading with telangiectasias and mild skin atrophy
  • Topical corticosteroids are discontinued
  • Dermatologic, rheumatologic, and cardiac follow-up evaluation is recommended