ISSN:
1365-4632
Source:
Blackwell Publishing Journal Backfiles 1879-2005
Topics:
Medicine
Notes:
A 30-year-old woman with a history of cutaneous lupus erythematosus (LE) developed lupus miliaris disseminatus faciei (LMDF) during her 32nd gestational week ( 〈link href="#f1"〉Fig. 1). After the birth of a healthy daughter, the skin lesions improved without treatment. A worsening of LMDF 6 months later was treated with 20 mg isotretinoin (0.3 mg/kg body weight) in combination with an oral contraceptive. The skin lesions improved significantly after 1 month of systemic treatment; however, 4 months later, new lesions occurred on both cheeks, and were diagnosed as cutaneous LE ( 〈link href="#f2"〉Fig. 2). Systemic isotretinoin therapy was discontinued and local application of a prednicarbate-containing ointment was initiated, leading to an improvement of the skin manifestations.〈figure xml:id="f1"〉1〈mediaResource alt="image" href="urn:x-wiley:00119059:IJD548:image_n/ijd548.f1"/〉Lupus miliaris disseminatus faciei (LMDF)〈figure xml:id="f2"〉2〈mediaResource alt="image" href="urn:x-wiley:00119059:IJD548:image_n/ijd548.f2"/〉Cutaneous lupus erythematosus; flare-up after healing of LMDFHistopathologic examination of an erythematous papule of the cheek revealed necrotic areas in the dermis surrounded by giant and epithelioid cells, as well as an inflammatory infiltrate around the hair follicles with lymphocytes, granulocytes, and histiocytes ( 〈link href="#f3"〉Fig. 3). A skin biopsy taken from an erythematous plaque of the face revealed a thin epidermis with vacuolization of the dermo–epidermal junction, as well as necrotic keratinocytes, lymphocytic infiltrates, and the deposition of mucin, consistent with the diagnosis of LE ( 〈link href="#f4"〉Fig. 4). Antinuclear antibodies (ANA) were positive (titer, 1 : 320), all routine laboratory parameters were within normal limits, and no anti-cardiolipin, -Ro/SSA, or -La/SSB antibodies were detectable.〈figure xml:id="f3"〉3〈mediaResource alt="image" href="urn:x-wiley:00119059:IJD548:image_n/ijd548.f3"/〉Caseation necrosis in the dermis surrounded by giant and epithelioid cells, and inflammatory infiltrates around the hair follicles with lymphocytes, granulocytes, and histiocytes, consistent with the diagnosis of LMDF〈figure xml:id="f4"〉4〈mediaResource alt="image" href="urn:x-wiley:00119059:IJD548:image_n/ijd548.f4"/〉Lymphocytic infiltrates, vacuolar degeneration, and deposition of mucin, consistent with the diagnosis of lupus erythematosusThe clinical course of this patient suggests that possible common pathogenetic pathways of LMDF and LE may involve a localized autoimmune-like process initially restricted to the site of the sebaceous glands, and in both diseases antigen expression may be provoked by UV radiation, hormonal, or viral factors.
Type of Medium:
Electronic Resource
URL:
http://dx.doi.org/10.1046/j.1365-4362.1998.00548.x
Permalink
