Provost T T, Zone J J, Synkowski D, Maddison P J, Reichlin M
J Invest Dermatol. 1980 Dec;75(6):495-9. doi: 10.1111/1523-1747.ep12524310.
Ten of 143 systemic lupus erythematosus patients demonstrated urticaria-like lesions. Lesional biopsies in 7 of 9 patients tested revealed a leukocytoclastic angiitis and in 2, a mononuclear perivascular infiltrate. Direct immunofluorescent studies in 2 of 6 patients tested revealed IgM and C3 deposition in and about dermal blood vessels. Nine of the 10 systemic lupus erythematosus, patients displayed active clinical disease (e.g., arthritis, renal disease, etc.), a positive lupus band test, antibodies against deoxyribonucleic acid or Sm macromolecules, serum hypocomplementemia and markedly elevated quantities of serum immune complexes as determined by an immunoradiometric assay employing Raji cells. Similar lesions were not detected in 35 discoid lupus erythematosus patients. These studies strongly suggest: (1) urticaria-like lesions are uncommon cutaneous manifestations of systemic lupus erythematosus. (2) These urticaria-like lesions do not represent a classic IgE mediated urticaria. (3) These urticaria-like lesions generally occur in lupus erythematosus patients demonstrating clinical and/or serological evidence of systemic disease activity. (4) These lesions are probably secondary to immune complex deposition. We, therefore, conclude that all urticarial lesions in lupus erythematosus patients should be biopsied and the patient evaluated for active systemic disease.
143例系统性红斑狼疮患者中有10例出现了荨麻疹样皮损。9例接受检测的患者中，7例皮损活检显示白细胞破碎性血管炎，2例显示血管周围单核细胞浸润。6例接受检测的患者中，2例直接免疫荧光研究显示真皮血管内及血管周围有IgM和C3沉积。10例系统性红斑狼疮患者中有9例表现为活动性临床疾病（如关节炎、肾脏疾病等），狼疮带试验阳性，抗脱氧核糖核酸或Sm大分子抗体阳性，血清补体降低，采用Raji细胞的免疫放射分析测定血清免疫复合物数量显著升高。35例盘状红斑狼疮患者未检测到类似皮损。这些研究强烈提示：（1）荨麻疹样皮损是系统性红斑狼疮罕见的皮肤表现。（2）这些荨麻疹样皮损并非典型的IgE介导的荨麻疹。（3）这些荨麻疹样皮损通常发生在有系统性疾病活动临床和/或血清学证据的红斑狼疮患者中。（4）这些皮损可能继发于免疫复合物沉积。因此，我们得出结论，红斑狼疮患者所有的荨麻疹样皮损均应进行活检，并对患者评估有无活动性系统性疾病。
