Relationship Between Cutaneous and Systemic Lupus Erythematosus

Abstract

ease characterized by highly varied clinical manifestations in association with autoantibody production (antinuclear antibodies [ANAs], anti-double-stranded DNA [dsDNA] antibodies, and anti-extractable nuclear antigen antibodies). Next to, for instance, kidneys, brain, heart, and joints, the skin is one of the organs typically affected in lupus. Cutaneous manifestations of lupus erythematosus (LE) appear frequently at the beginning or in the course of SLE, but they may also occur without systemic involvement.This book deals with a broad spectrum of cutaneous forms of lupus with respect to the clinic, pathophysiology, and treatment. The aim of this chapter is to analyze what the skin is telling us about the autoimmune process below the surface. Several analyses tried to predict the clinical situation of the patients by their antibody profile or their genetic background,but as every patient with lupus is writing his or her own chapter in the book of lupus,the value of these attempts are limited.Even if we can read the disease activity in some cases from the cutaneous manifestations only, the pages in this chapter describing the skin lesions of an individual patient outline the whole disease. According to the “Dusseldorf Classification 2003,” the cutaneous manifestations of LE are subclassified in four lupus-specific types (Kuhn 2003): • Acute cutaneous lupus erythematosus (ACLE) • Subacute cutaneous lupus erythematosus (SCLE) • Chronic cutaneous lupus erythematosus (CCLE) – Discoid lupus erythematosus (DLE) – Lupus erythematosus profundus (LEP) – Lupus erythematosus hypertrophicus/verrucous (HVLE) – Chilblain lupus erythematosus (CHLE) • Intermittent cutaneous lupus erythematosus (ICLE) – Lupus erythematosus tumidus (LET)