Department of Dermatology, Kansai Medical University, Hirakata, Japan.
Department of Rheumatology and Clinical Immunology, Kansai Medical University, Hirakata, Japan.
Lupus. 2020 Jan;29(1):79-82. doi: 10.1177/0961203319890677. Epub 2019 Dec 1.
Antimalarials are usually recommended for the first-line systemic treatment of cutaneous lupus erythematosus. Alopecia in patients with discoid lupus erythematosus (DLE) is sometimes a refractory condition in spite of topical therapies. We herein described a case of DLE on the scalp with a pathological change of a xanthomatous reaction, which was successfully treated with hydroxychloroquine (HCQ). A 34-year-old woman presented with hair loss to the parietal region. She had been diagnosed with systemic lupus erythematosus (SLE) four years previously. Treatment with 30 mg/day of prednisolone (PSL) had been initiated, and the dose was gradually reduced. At 10 mg/day of PSL, she had noticed her hair loss. Physical examination revealed some small erythematous lesions to the parietal region with accompanying hair loss. Pathological findings of the erythematous lesion on her head revealed thickening of the basement membrane zone, the interface dermatitis with vacuolar degeneration, and both superficial perivascular and perifollicular infiltration of inflammatory cells in the dermis. In addition, there was an infiltrate of xanthomatous cells detected in the papillary dermis, which were positive for CD68 and CD163. The patient started treatment with HCQ at a dose of 200 mg/day. The skin lesions completely resolved within five months after initiation of HCQ without increase in the dose of PSL. Xanthomatous reactions are rarely recognized in lupus erythematosus. The chronic epithelial injury in DLE could be implicated in triggering the secondary reactive process of a xanthomatous reaction. We believe that the reaction seen in our patient was a secondary change to pathological alteration due to SLE. However, as yet unrecognized factors may play a role in the development of a xanthomatous reaction in DLE.
抗疟药通常被推荐用于治疗皮肤红斑狼疮的一线系统性治疗。尽管采用了局部治疗，盘状红斑狼疮（DLE）患者的脱发有时仍是一种难治性疾病。我们在此描述了一例头皮 DLE 病例，其病理变化为黄瘤反应，羟氯喹（HCQ）治疗取得了成功。一名 34 岁女性因头顶脱发就诊。四年前她被诊断为系统性红斑狼疮（SLE）。开始用 30mg/天的泼尼松龙（PSL）治疗，并逐渐减少剂量。当 PSL 剂量为 10mg/天时，她注意到自己脱发。体格检查发现头皮有一些小的红斑性皮损，伴有脱发。头部红斑性皮损的病理发现为基底膜带增厚，界面性皮炎伴空泡变性，真皮浅层血管周围和毛囊周围均有炎症细胞浸润。此外，在乳头真皮中还发现了黄瘤细胞浸润，这些细胞对 CD68 和 CD163 呈阳性。患者开始用 HCQ 治疗，剂量为 200mg/天。HCQ 治疗开始后五个月内，皮肤病变完全消退，PSL 剂量未增加。黄瘤反应在红斑狼疮中很少被认识。DLE 中的慢性上皮损伤可能与触发黄瘤反应的继发性反应过程有关。我们认为，我们患者所见的反应是由于 SLE 导致的病理改变的继发性变化。然而，尚未识别的因素可能在 DLE 中黄瘤反应的发生中起作用。
