Abstract
Background: Lupus erythematous (LE) describes a spectrum of auto immune disorders, involving whole body (systemic LE) in one end and cutaneous limited LE on the other side. Cutaneous LE mainly diagnosed via clinical manifestations as well as histopathologic examination. According to different pathologic specifications, the aim of present study was to determine which histopathologic criterion is more accurate and practical in diagnosing cutaneous LE. Material and Methods: Samples taken from patients with clinical manifestations of Cutaneous LE with pathologic confirmation, included. All patients had direct immuno fluorescent (DIF) samples that recorded. Histopathologic findings are categorized into three groups: group 1 contains epidermal changes, group 2 includes interface changes and group 3 contains dermal changes. Different histopathologic finding such as perivascular infiltration, follicular atrophy, follicular plaque, and basements membrane thickness and other changes, as well as DIF patterns, were recorded in designed questionnaires to further analysis with SPSS software. Results: Of 145 patients (61.4% female and 38.6% male) in 58.6% DLE was the first clinical diagnosis,23% was the second and in subsequent 4.1%, 1.4% and 0.7% was third, fourth and fifth diagnosis respectively. In 11% of caeses DLE was not among clinical impressions. DIF was positive in 49%. As a whole, superficial perivascular and perifolicular infiltration were observed in 99% of the cases and was the commonest pathologic feature followed by basal vacuolization, peri follicular infiltration and epidermal atrophy. Other pathologic changes were observed with variable rates. Discussion: By grouping histopathologic criterion, it seems that hyperkeratosis and thickening of Basement membrane may be major histologic criterion and peri vascular infiltration, peri follicular infiltration and eccrine gland infiltration, may be minor.
Highlights
Genetic, hormones, and environment play altogether to give birth to lupus erythematosus (LE); a disease of autoimmune features with a more frequency in women especially in childbearing age which can present variously in different involved organs
There is a variant of DLE called tumid lupus erythematosus (TLE) which is recognized by excess production of mucin in derma giving the skin a brawny appearance with indurations
Lupus band test by using immunofluorescence shows how autoantibodies of IgG, IgM, and IgA type have deposited over the dermoepidermal junction (DEJ); it is notable that its definition from a test confined to the skin lesions have expanded to all the areas on the skin of peoples with Lupus erythematosus (LE) whether in the sun exposed or protected areas of the body [21-28]
Summary
Hormones, and environment play altogether to give birth to lupus erythematosus (LE); a disease of autoimmune features with a more frequency in women especially in childbearing age which can present variously in different involved organs. The aforesaid disease could be manifested from a skin lesion (cutaneous lupus) to a fatal diffused type (systemic lupus erythematosus [SLE]). LE is clinically divided to three classes: systemic lupus with acute onset, sub- acute cutaneous type, and a chronic discoid form (discoid lupus erythematosus [DLE]). Lupus erythematosus (LE) includes a spectrum of auto immune disorders, involving whole body (systemic LE) in one end and is cutaneous limited LE on the other side. Cutaneous LE mainly diagnosed via clinical manifestations as well as histopathologic examination. According to different pathologic specifications, the aim of present study was to determine which histopathologic criterion is more accurate and practical in diagnosing cutaneous LE
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