Panse I, Cordoliani F, Rybojad M, Rivet J, Lebbé C, Morel P
Service de Dermatologie, Hôpital Saint-Louis, Paris.
Ann Dermatol Venereol. 2004 Jan;131(1 Pt 1):58-60. doi: 10.1016/s0151-9638(04)93544-2.
Discoid lupus erythematosus is a chronic skin disease frequently involving the face, scalp and ears. Palpebral lesions are rare. We report 4 cases of this uncommon localization. In one case, palpebral lesions were the sole manifestation of the discoid lupus erythematosus.
Four patients aged between 26 and 45 Years had lesions of the lower eyelid as erythematous, infiltrated and scaly plaques. One patient, without diagnosis despite 2 skin biopsies of lesion, presented with a 2-Year history of blepharitis in the absence of any other cutaneous abnormality. In one case, chronic blepharitis has been present for 4 Years and associated with inflammatory arthralgia. Alopecia occurred 4 Years after the onset of blepharitis and led to the diagnosis of discoid lupus erythematosus. In 2 cases, blepharitis was associated with typical cutaneous lesions of discoid lupus erythematosus. Antimalaria drugs were very effective in 3 cases. In one patient the antimalaria drug failed, but thalidomide was effective.
The location of lesions on the eyelids in the absence of any other cutaneous abnormality is rare and can easily lead to the misdiagnosis of discoid lupus erythematosus. Most Authors mention a predilection of the lesions to the inferior portion of the eyelid, more specifically to the external third. The involvement of the eyelids with permanent scarring and severe eye impairment is explained by the long duration of the disease without diagnostic and appropriate treatment. Clinical examination is highly consistent with discoid lupus erythematosus: the lesions typically present as well-circumscribed, erythematous plaques with telangiectasia and scales and atrophy in long-standing disease. Antimalaria drugs are remarkably effective.
盘状红斑狼疮是一种慢性皮肤病，常累及面部、头皮和耳部。眼睑病变较为罕见。我们报告4例这种不常见的病变部位情况。其中1例，眼睑病变是盘状红斑狼疮的唯一表现。
4例年龄在26至45岁之间的患者，下眼睑出现红斑、浸润性鳞屑斑块病变。1例患者尽管对病变进行了2次皮肤活检仍未确诊，有2年睑缘炎病史，无任何其他皮肤异常。1例患者慢性睑缘炎已存在4年，并伴有炎性关节痛。睑缘炎发病4年后出现脱发，从而诊断为盘状红斑狼疮。2例患者睑缘炎与盘状红斑狼疮典型的皮肤病变相关。抗疟药在3例患者中非常有效。1例患者抗疟药治疗无效，但沙利度胺有效。
在无任何其他皮肤异常的情况下，病变位于眼睑的情况罕见，容易导致盘状红斑狼疮的误诊。大多数作者提到病变易发生于眼睑下部，更具体地说是外侧三分之一处。眼睑受累并伴有永久性瘢痕形成和严重眼部损害是由于疾病长期未得到诊断和适当治疗所致。临床检查与盘状红斑狼疮高度相符：病变通常表现为边界清晰的红斑斑块，伴有毛细血管扩张、鳞屑，在病程较长时出现萎缩。抗疟药疗效显著。
