Department of Experimental, Diagnostic and Specialty Medicine, Division of Dermatology, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy.
Department of Medical Sciences, Section of Dermatology, University of Turin, Turin, Italy.
Dermatol Ther. 2021 Mar;34(2):e14743. doi: 10.1111/dth.14743. Epub 2021 Jan 12.
Palmo-plantar lesions in discoid lupus erythematosus (DLE) can be considered a very distinct rarity, generally refractory to conventional treatments. We present a 47-year-old African female patient with a 6-month clinical history of palm and soles erosions. Clinical examination revealed painful multiple, well defined, erosions with an erythematous and scaly central area and peripherical post-inflammatory hyperchromic border bilaterally distributed on the palmo-plantar surfaces. Pterygium inversum unguis involved all nails of both hands. Histological analysis and direct immunofluorescence study confirmed palmo-plantar DLE. Therapy with mycophenolate mofetil (MMF) was initiated with a progressive clearing of palmo-plantar lesions and a drastic reduction of pain. Therapy was well tolerated, neither side effects nor altered laboratory investigations were observed. Our case and literature review confirm that MMF may be an effective approach for the management of refractory palmo-plantar DLE with a safer profile than Azathioprine regarding adverse effects and cutaneous malignancies risk.
盘状红斑狼疮（DLE）的掌跖病变可被视为非常罕见的情况，通常对常规治疗有抗性。我们介绍一位 47 岁的非洲女性患者，其手掌和足底有 6 个月的侵蚀性临床病史。临床检查显示双侧手掌和足底表面有多个疼痛性、界限分明的侵蚀性病变，中央区域呈红斑和鳞屑状，周围有炎症后色素沉着边界。指甲反甲累及双手所有指甲。组织学分析和直接免疫荧光研究证实为掌跖部 DLE。我们采用吗替麦考酚酯（MMF）进行治疗，掌跖病变逐渐消退，疼痛明显减轻。治疗耐受性良好，未观察到不良反应或实验室检查异常。我们的病例和文献复习证实，与硫唑嘌呤相比，MMF 可能是治疗难治性掌跖部 DLE 的有效方法，其在不良反应和皮肤恶性肿瘤风险方面的安全性更高。
