Renner R, Sticherling M
Clinic for Dermatology, Venerology and Allergology, University of Leipzig, Germany.
G Ital Dermatol Venereol. 2009 Apr;144(2):135-47.
Lupus erythematosus is a chronic and inflammatory multiorgan disease with variable clinical appearance and variable course. Most patients with systemic lupus erythematosus show cutaneous manifestations and conversely, all forms of cutaneous LE may change into a systemic involvement. Specific lesions of cutaneous LE are classified in different subtypes of acute cutaneous lupus erythematosus (ACLE), subacute cutaneous lupus erythematosus (SCLE), chronic cutaneous lupus erythematosus (CDLE) and intermittent cutaneous lupus erythematosus (ICLE) according to clinical, histological and immunoserological parameters. Regular laboratory tests are important to monitor the activity and course of the disease or side effects of the therapy. In case of clinical or laboratory dysfunctions of internal organs, additional technical investigations are necessary. Histology is needed to support clinical diagnosis. A large number of drugs are able to induce SCLE, e.g. hydrochlorothiazide, terbinafine, or angiotensin-converting enzyme inhibitors. Drug-induced SCLE can be differentiated by possible complementary immunoserological parameters. Neonatal lupus can be induced by transplacental transmission of maternal anti-Ro(SS-A) and anti-La(SS-B)-antibodies. Children with neonatal lupus might suffer from congenital atrioventricular block. Their mothers may suffer from active LE, but can be clinically healthy as well. As a consequence, pregnancies at risk should be monitored in short intervals by serial echocardiographic interventions. Protection against UV light is recommended for all types of CLE. There are some topical and many systemic treatment options e.g. topical and systemic glucocorticosteroids, antimalarial drugs, dapsone, azathioprine, or mycophenolate mofetil with different response to skin or organ involvement.
红斑狼疮是一种慢性炎症性多器官疾病,临床表现多样,病程各异。大多数系统性红斑狼疮患者有皮肤表现,反之,所有类型的皮肤型红斑狼疮都可能转变为系统性病变。皮肤型红斑狼疮的特定皮损根据临床、组织学和免疫血清学参数分为不同亚型,即急性皮肤型红斑狼疮(ACLE)、亚急性皮肤型红斑狼疮(SCLE)、慢性皮肤型红斑狼疮(CDLE)和间歇性皮肤型红斑狼疮(ICLE)。定期进行实验室检查对于监测疾病的活动度、病程或治疗副作用很重要。如果出现内脏器官的临床或实验室功能障碍,则需要进行额外的技术检查。组织学检查有助于支持临床诊断。大量药物可诱发SCLE,如氢氯噻嗪、特比萘芬或血管紧张素转换酶抑制剂。药物诱发的SCLE可通过可能的补充免疫血清学参数进行鉴别。新生儿狼疮可由母体抗Ro(SS - A)和抗La(SS - B)抗体经胎盘传播诱发。患有新生儿狼疮的儿童可能患有先天性房室传导阻滞。他们的母亲可能患有活动性红斑狼疮,但也可能临床健康。因此,有风险的妊娠应通过系列超声心动图检查进行短期监测。建议所有类型的皮肤型红斑狼疮患者都要避免紫外线照射。有一些局部治疗和多种全身治疗选择,如局部和全身糖皮质激素、抗疟药、氨苯砜、硫唑嘌呤或霉酚酸酯,对皮肤或器官受累的反应各不相同。