Internal Medicine

0521779407-C04 CUNY1086/Karliner 0 521 77940 7 June 14, 2007 20:37

Cutaneous Larva Migrans Cutaneous Lupus Erythematosus (LE) 441

complications and prognosis

■Secondary bacterial infection, tetanus. Prognosis otherwise excel-

lent.

Cutaneous Lupus Erythematosus (LE).....................

RICHARD D. SONTHEIMER, MD and JEFFREY P. CALLEN, MD

history & physical

■Acute Cutaneous LE (ACLE) – rash on cheeks and nose of face.

Most often appears after sun exposure. Less common features: scaly,

bumpy, edema. Rarely blisters. Can come and go quite quickly. Some-

time extends to outer arms, dorsal hands (sparing the knuckles), and

other parts of the upper body. Leg involvement rare.

■Subacute Cutaneous LE (SCLE) – psoriasis-like scaly rash or

ringworm-shaped scaly rash on the sun-exposed areas of the outer

arms, backs of hands, neck, shoulders, upper trunk. Relative sparing

of central face. Can be precipitated by treatment with some sys-

temic drugs (e.g., more commonly – hydrochlorothiazide, diltiazem,

terbinafine, cinnarizine; less commonly – griseofulvin, naproxen,

aldactone, captopril, cilazapril, verapamil, nifedipine, interferon

beta, ranitidine, piroxicam, D-penicillamine, sulfonylureas, pro-

cainamide, oxyprenolol, gold salts).

■Discoid LE (DLE) – scaly, coin-shaped skin changes that usually

develop on the scalp and face. Commonly produces circumscribed

hair loss.

➣All – red skin lesions, photosensitivity, absence of pruritus, pain

or tenderness in lesions

Signs & Symptoms

■ACLE – symmetrical, butterfly-shaped erythematous skin on malar

eminences and bridge of nose (with or without associated papules

and mild scale). Sometimes presents as a predominately papular

eruption.

■SCLE – discrete or confluent, non-indurated, scaly psoriasis-like

plaques (psoriasiform) or ring-shaped (annular) lesions on the sun-

exposed areas of upper trunk, neck and arms with relative sparing

of the central face. Central face involvement suggests concurrent

presence of ACLE.

■DLE – localized (above the neck only) or generalized (above

and below the neck) scaly, coin-shaped plaques or nodules of