Systemic Lupus Erythematosus
Systemic lupus erythematosus Figures 19-1 and 19-2 illustrate cutaneous involvement of systemic lupus erythematosus (SLE) in the classic butterfly pattern on the face. This macular and intensely erythematous eruption is frequently aggravated by sun exposure and may flare with other symptoms of systemic disease.
This autoimmune disease of unknown etiology affects almost every organ system. The most common findings in the child with SLE are fever, arthralgias, and arthritis. In addition, pleuritis, pericarditis, and central nervous system involvement are frequently seen in children with SLE. Lupus nephritis develops in the vast majority of affected children and may eventually cause renal failure.
Systemic lupus erythematosus These figures illustrate additional cutaneous features of SLE. The lesions on the back (Fig. 19-3) and the hands (Fig. 19-4) are intensely erythematous macules and slightly edematous papules and plaques. Childhood SLE occurs most frequently during adolescence and is more common among African-Americans and among girls.
Clinical criteria include rash (either malar or discoid), photosensitivity, oral ulcers, and disease of the joints, lungs, kidneys, and central nervous system.
Systemic lupus erythematosus Figure 19-5 shows the temporary alopecia that is also a hallmark of SLE. The single most reliable laboratory test for SLE is antinuclear antibody which will be positive in almost every case of childhood SLE. Other laboratory criteria include leukopenia, thrombocytopenia, and the presence of antinative DNA antibodies.
Involvement of the distal fingers is a common occurrence in children with SLE. Findings include telangiectasia of the nail folds, splinter hemorrhages, and digital infarcts as shown in Fig. 19-6.
Systemic Lupus Erythematosus Vasculitis
Systemic lupus erythematosus vasculitis Cutaneous vasculitis occurs commonly in patients with SLE. The vasculitis may lead to ulceration as shown in Fig. 19-7.
Neonatal Lupus Erythematosus
Neonatal lupus erythematosus This condition is primarily due to the transplacental passage mainly of anti-Ro (anti-SS-A) antibodies from mother to infant. Maternal anti-La (anti-SS-B) and anti-RNP antibodies may be implicated. The mother may herself suffer from a form of connective tissue disease or may be completely asymptomatic.
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