Before Gilliam and Sontheimer classified it as a distinct entity, lesions of SCLE were referred to with varied nomenclature including symmetric erythema centrifugum, disseminated DLE, autoimmune annular erythema, subacute disseminated LE, superficial disseminated LE, psoriasiform LE, pityriasiform LE, and maculopapular photosensitive LE (Sontheimer et al. 1979).
Cutaneous lesions of SCLE typically begin with red macules or papules which evolve into psoriasiform and/or annular plaques on sun-exposed skin, characteristically the shoulders, upper back, extensor arms, V of the lower neck and upper chest, and back of the neck. The face is less commonly affected. Annular lesions tend to expand with central clearing and trailing scale. When active inflammation resolves, hypopigmentation is common, especially in the inactive centers of annular lesions. In Sontheimer's original cohort half presented with predominantly papulosquamous and half with predominantly annular lesions. Parodi reported similar findings (Parodi et al. 2000), whereas some cohorts have had a majority of annular lesions (Herrero et al. 1988; Chlebus et al. 1998; Black et al. 2002) and some have had a majority of papulosquamous lesions (Molad et al. 1987; Callen and Klein 1988; Cohen and Crosby 1994).
Atypical presentations of SCLE occur, including vesiculo-bullous forms. Well before the classification of SCLE as a subset of LE, Rowell et al. (1963), described EM-like (erythema multiforme) lesions in four so-called DLE patients who had a speckled ANA, rheumatoid factor and precipitating antibodies to the saline extract of human tissues (anti-Sj-T). Whereas EM and DLE can coexist, it has been suggested that Rowell's syndrome should now be reclas-sified as SCLE (Roustan et al. 2000). Lyon et al. (1998) reported two cases of delayed diagnosis of SCLE because of the clinical and histologic similarities between SCLE and EM. Additional cases of EM-like SCLE lesions have been reported (Massone et al. 2000). In one patient the lesions developed changes similar to toxic epidermal necrolysis (Bielsa et al. 1987). Marginal vesicles were clinically evident in 38% of annular SCLE lesions that Herrero et al. observed (1988).
Rarer presentations of SCLE have also been reported including a morbil-liform exanthem (Sontheimer 1985), exfoliative erythroderma (DeSpain and Clark 1988; Parodi et al. 2000), pityriasiform lesions (Sontheimer 1989; Parodi et al. 2000; Caproni et al. 2001), peculiar acral annular plaques (Scheinman 1994), progressive generalized poikiloderma (Pramatarov et al. 2000; Marzano et al. 2003b), sunlight induced papulonodular mucinosis (Sonntag et al. 2003), generalized erythroderma with acral bullae preceeding SCLE (Mutasim, 2003) and annular SCLE lesions that were eventually replaced by morphea (Rao et al. 1990).
SCLE patients may have other LE specific skin lesions. Localized ACLE not uncommonly occurs in the setting of SCLE and is characterized by an erythematous, edematous malar rash in a butterfly pattern that usually spares the nasolabial folds (Sontheimer 1989). Localized ACLE is usually more transient than SCLE and usually heals without scarring or pigmentary changes. Sontheimer has anecdotally suggested that the individuals who developed ACLE following SCLE might be predisposed to eventually developing findings of SLE such as nephritis (Sontheimer 1989).
Classical DLE is the most common form of CCLE and may be seen in some SCLE patients. DLE lesions are more common on the scalp and face and have more hypopigmentation, hyperpigmentation, scarring, follicular plugging, and adherent scale than SCLE lesions. Induration was the most important clinical feature differentiating DLE from SCLE lesions (David-Bajar et al. 1992). Lupus panniculitis, often reported in association with DLE, has recently been reported in association with SCLE (Morgan & Callen 2001).
SCLE patients may also have LE nonspecific skin findings. The most common are diffuse alopecia, mucositis, livedo reticularis, periungual telangiec-tasias, small vessel vasculitis, Raynaud's phenomenon, cutaneous sclerosis (Sontheimer 1989), and red lunulae (Wollina et al. 1999). Dystrophic calcinosis cutis (Marzano et al. 1999), multiple HPV-11 cutaneous squamous cell carcinomas (Cohen et al. 1992), and erythema gyratum repens, a rare paraneoplastic eruption (Hochedez et al. 2001), have been case reported.
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Rosacea and Eczema are two skin conditions that are fairly commonly found throughout the world. Each of them is characterized by different features, and can be both discomfiting as well as result in undesirable appearance features. In a nutshell, theyre problems that many would want to deal with.