Internal Medicine

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

444 Cutaneous Lupus Erythematosus (LE) Cutaneous Vasculitis

can have prolonged treatment-free remissions). Watch for develop-

ment of intercurrent SLE.

complications and prognosis

■ACLE – associated with high risk of SLE. Ultimate prognosis is depen-

dent on severity of SLE.

■SCLE – Post-inflammatory hyperpigmentation and hypopigmenta-

tion. Course marked by intermittent periods of skin disease activity.

Risk for developing Sjogren’s syndrome is approximately 20%; for

clinically significant SLE, approximately 10%.

■DLE – severe dystrophic scarring of skin and permanent hair loss

that can be psychosocially and occupationally disabling. <5% risk of

developing clinically significant SLE when isolated DLE lesions are

the presenting manifestation of the disease.

Cutaneous Vasculitis..................................

VICTORIA P. WERTH, MD

history & physical

Risk Factors

■Infection:Hepatitis B or C, rarely A, acute respiratory infections (viral

or bacterial), streptococcal, bacterial endocarditis, intestinal bypass

syndrome, mycobacterial

■Drugs:most common – aspirin, sulfonamides, penicillins, barbitu-

rates, amphetamines, propylthiouracil, TNF inhibitors

■Rheumatic diseases:Systemic lupus erythematosus, rheumatoid

arthritis, dermatomyositis, Sjogren’s syndrome

■Abnormal globulins:cryoglobulinemia, myeloma

■Genetic:complement deficiency

■Other:ulcerative colitis, malignancy

Signs & Symptoms

■Small vessel vasculitis:

➣palpable purpura (often in dependent areas like legs) or urticaria-

like, less commonly vesiculobullous, pustules, cutaneous necro-

sis, ulceration

➣Can have symptomatic involvement of other organs. Gastroin-

testinal tract symptoms include colicky pain, hemorrhage, ulcer-

ation, and perforation.

➣Kidney involvement is usually asymptomatic.