kuliah Discoid-lupus-erythematous-anto.ppt

lupus

1. DISCOID LUPUS DISCOID LUPUS
ERYTHEMATOSUSERYTHEMATOSUS

2. Discoid Lupus erthematosus
(DLE) is a chronic inflammatory
dermatosis, that probably
induced by autoimmune
processes & results in sharply
demarcated erythematokeratotic
lesions which heal with atopic
scarring.
Definition

3. 15 – 30% of SLE populations.
Most common in individuals
between 20 & 40 years of
age.
Female : Male ratio of 3 : 2 to
3 : 1.
More prevalent in blacks.
Epidemiology

4. Etiologic factors include :
•UV radiation.
•Viral infection.
•Drug & chemical
exposure.
•Cigarette smoking.
Etiology

5. Pathogenesis
Neoantigen formation /
autoantigen modulation.
Exaggerated release of
immune mediators.
Perturbation of cutaneous
immunoregulatory circuits.

6. Begin as red-purple
macules, papules or small
plaques & rapidly develop a
hyperkeratotic surface.
Clinical manifestation

7. Sharply demarcated, coin-
shaped erythematous plaques
covered by a prominent,
adherent scale that extends
into the orifices of dilated hair
follicles.

8. Most frequently encountered
on the face, scalp, ears, V
area of the neck, & extensor
aspects of the arm.

9. Laboratorium Findings
ANA is present in low titer in
30 – 40% of patients with
DLE.
Antibodies to single stranded
DNA are not uncommon
Antibodies to U1RNP are
sometimes found.

10. Histopathology
Epidermis is athopic.
Compact orthohyper-
keratosis with follicular
keratosis.

11. Cells of basal layer show
vacuolar degeneration.
Hyaline thickening of the
PAS-reactive basement
membrane.

12. Diagnosis
Triad of erythema,
keratosis, & atrophy.
Hyperesthesia & Tack
phenomenon.
Confirmed by histo-
phatological & DIF tests.

13. Differential Diagnosis
Lupus vulgaris.
Psoriasis vulgaris.
Seborrheic eczema.
Actinic keratoses.
Tinea faciei / corporis.

14. Treatment
Sun protection :
Avoid direct exposure.
Use broad spectrum, water
resistant sunscreens SPF
 15 with an efficient UVA
blocking agent.
A. Local Therapy

15. Local glucocorticoids :
Triamnicolone acetonide
0.1%.
Clobetasol propionate
0.05%.
Bethmethazone dipropionate
0.05%.

16. Intra lesional gluco-
corticoids :
Triamnicolone Acetonide
suspension 2.5 - 5 mg/ml.

17. Anti malarias :
Hydroxychloroquine
sulfate 400 mg PO / day for
first 6 - 8 weeks &
decrease to a maintenance
dose of 200 mg / day for at
least a year.
B. Systemic therapy

18. Systemic glucocorticoids :
Prednisone : 20 - 40 mg /
day / single dose &
reduced by 5 - 10 mg
decrements until activity
flares again or until a daily
dosage of 20 mg/day is
achieved.

19. Other immunosuppressives :
Azathioprine : 1.5 – 2 mg
/kg/day/PO.
Methotrexate : 7.5 mg PO
one day per week.

20. Prognosis
Favorable for live, but
difficult healing is to be
expected.