Black A A, McCauliffe D P, Sontheimer R D
Department of Dermatology, University of Texas Southwestern Medical Center, Dallas 75235.
Lupus. 1992 Aug;1(4):229-37. doi: 10.1177/096120339200100406.
There are many causes of malar erythema besides the classic butterfly rash of acute cutaneous lupus erythematosus (LE). Twenty-one patients (6.7% of new patient visits) referred to a dermatology department-based rheumatic skin disease subspecialty clinic over a 5-year period in whom a diagnosis of cutaneous LE had been entertained were found to have diagnoses other than autoimmune connective tissue diseases. Sixteen of the patients in this cohort (76%) had acne rosacea (rosacea), while the remaining five had other dermatologic disorders. Review of their records revealed that upon referral nine of these 21 patients (43%) had positive antinuclear antibody (ANA) assays, most with insignificant or marginal titers by our laboratory standards. On repeat ANA testing in our laboratory, all of these patients had insignificant ANA titers. Physicians may be giving too much weight to low-titer ANAs in assessing patients with isolated malar erythema. These issues are discussed in the overall context of the differential diagnosis of malar erythema. A simple punch skin biopsy can be very helpful in distinguishing cutaneous LE from other causes of malar erythema.
除了急性皮肤型红斑狼疮（LE）典型的蝶形皮疹外，还有许多导致颧部红斑的原因。在5年期间转诊至一家以皮肤科为基础的风湿性皮肤病专科门诊的患者中，有21例（占新就诊患者的6.7%）曾被考虑诊断为皮肤型LE，但最终确诊并非自身免疫性结缔组织病。该队列中的16例患者（76%）患有玫瑰痤疮，其余5例患有其他皮肤病。回顾他们的病历发现，这21例患者中有9例（43%）转诊时抗核抗体（ANA）检测呈阳性，按照我们实验室的标准，大多数患者的滴度无意义或处于临界值。在我们实验室进行重复ANA检测时，所有这些患者的ANA滴度均无意义。医生在评估孤立性颧部红斑患者时，可能过于看重低滴度ANA。这些问题将在颧部红斑鉴别诊断的整体背景下进行讨论。简单的钻孔皮肤活检对于区分皮肤型LE和其他导致颧部红斑的原因非常有帮助。
