Manifestações cutâneas no lúpus eritematoso

o que o clínico precisa saber

Autores

  • Bruno de Castro e Souza Faculdade de Medicina da Universidade de São Paulo
  • José Antonio Sanches Faculdade de Medicina da Universidade de São Paulo

Palavras-chave:

Lúpus eritematoso cutâneo, lúpus eritematoso discoide, lúpus eritematoso sistêmico, paniculite de lúpus eritematoso, dermatologia

Resumo

O lúpus eritematoso é uma doença autoimune complexa que afeta diversos órgãos. A pele é o segundo local mais acometido e as manifestações cutâneas são divididas em específicas e não específicas. As primeiras possuem em comum o achado histopatológico de dermatite de interface com degeneração vacuolar da camada basal e infiltrado linfocitário na junção dermoepidérmica e são subdivididas em agudas, subagudas e crônicas. As manifestações não específicas compõem um grupo heterogêneo de condições que frequentemente está associado ao lúpus eritematoso sistêmico. O conhecimento e a interpretação adequada de tais manifestações é importante, pois, além da relevância diagnóstica, as lesões cutâneas nos dão informações prognósticas. Portanto, é imprescindível que o clínico conheça as principais manifestações cutâneas do lúpus eritematoso para a melhor condução desses pacientes.

Biografia do Autor

Bruno de Castro e Souza, Faculdade de Medicina da Universidade de São Paulo

Dermatologista e estudante de doutorado do Programa de Pós-Graduação em Dermatologia da Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo (SP), Brasil.

José Antonio Sanches, Faculdade de Medicina da Universidade de São Paulo

Professor titular do Departamento de Dermatologia da Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo (SP), Brasil.

Referências

Lee HJ, Sinha AA. Cutaneous lupus erythematosus: understanding of clinical features, genetic basis, and pathobiology of disease guides therapeutic strategies. Autoimmunity. 2006;39(6):433-44. PMID: 17060022; https://doi.org/10.1080/08916930600886851.

Jarukitsopa S, Hoganson DD, Crowson CS, et al. Epidemiology of systemic lupus erythematosus and cutaneous lupus erythematosus in a predominantly white population in the United States. Arthritis Care Res (Hoboken). 2015;67(6):817-28. PMID: 25369985; https://doi.org/10.1002/acr.22502.

Petersen MP, Möller S, Bygum A, Voss A, Bliddal MEpidemiology of cutaneous lupus erythematosus and the associated risk of systemic lupus erythematosus: a nationwide cohort study in Denmark. Lupus. 2018;27(9):1424-1430. PMID: 29788808; https://doi.org/10.1177/0961203318777103.

Gilliam JN, Sontheimer RD. Distinctive cutaneous subsets in the spectrum of lupus erythematosus. J Am Acad Dermatol. 1981;4(4):471-5. PMID: 7229150; https://doi.org/10.1016/s0190-9622(81)80261-7.

Callen JP. Cutaneous lupus erythematosus: Reflecting on practice-changing observations over the past 50 years. Clin Dermatol. 2018;36(4):442-9. PMID: 30047428; https://doi.org/10.1016/j.clindermatol.2018.04.002.

Biazar C, Sigges J, Patsinakidis N, et al. Cutaneous lupus erythematosus: first multicenter database analysis of 1002 patients from the European Society of Cutaneous Lupus Erythematosus (EUSCLE). Autoimmun Rev. 2013;12(3):444-54. PMID: 23000206; https://doi.org/10.1016/j.autrev.2012.08.019.

Watanabe T, Tsuchida T. Classification of lupus erythematosus based upon cutaneous manifestations. Dermatological, systemic and laboratory findings in 191 patients. Dermatology. 1995;190(4):277-83. PMID: 7655105; https://doi.org/10.1159/000246716.

Kuhn A, Landmann A. The classification and diagnosis of cutaneous lupus erythematosus. J Autoimmun. 2014;48-49:14-9. PMID: 24486120; https://doi.org/10.1016/j.jaut.2014.01.021.

Mainetti C, Terziroli Beretta-Piccoli B, Selmi C. Cutaneous Manifestations of Dermatomyositis: a Comprehensive Review. Clin Rev Allergy Immunol. 2017;53(3):337-56. PMID: 29090371; https://doi.org/10.1007/s12016-017-8652-1.

Wenzel J. Cutaneous lupus erythematosus: new insights into pathogenesis and therapeutic strategies. Nat Rev Rheumatol. 2019;15(9):519-32. PMID: 31399711; https://doi.org/10.1038/s41584-019-0272-0.

Alves F, Gonçalo M. Lupus Erythematosus: Cutaneous Manifestations and Treatment. Journal of the Portuguese Society of Dermatology and Venereology. 2019;77(3):201-14. https://doi.org/10.29021/spdv.77.3.1118.

Rothfield N, Sontheimer RD, Bernstein M. Lupus erythematosus: systemic and cutaneous manifestations. Clin Dermatol. 2006;24(5):348-62. PMID: 16966017; https://doi.org/10.1016/j.clindermatol.2006.07.014.

Udompanich S, Chanprapaph K, Suchonwanit P. Hair and Scalp Changes in Cutaneous and Systemic Lupus Erythematosus. Am J Clin Dermatol. 2018;19(5):679-94. PMID: 29948959; https://doi.org/10.1007/s40257-018-0363-8.

Chiewchengchol D, Murphy R, Edwards SW, Beresford MW. Mucocutaneous manifestations in juvenile-onset systemic lupus erythematosus: a review of literature. Pediatr Rheumatol Online J. 2015;13:1. PMID: 25587243; https://doi.org/10.1186/1546-0096-13-1.

Aringer M, Costenbader K, Daikh D, et al. 2019 European League Against Rheumatism/American College of Rheumatology Classification Criteria for Systemic Lupus Erythematosus. Arthritis Rheumatol. 2019;71(9):1400-12. PMID: 31385462; https://doi.org/10.1002/art.40930.

Tankunakorn J, Sawatwarakul S, Vachiramon V, Chanprapaph K. Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis-Like Lupus Erythematosus. J Clin Rheumatol. 2019;25(5):224-31. PMID: 29912772; https://doi.org/10.1097/rhu.0000000000000830.

Okon LG, Werth VP. Cutaneous lupus erythematosus: diagnosis and treatment. Best Pract Res Clin Rheumatol. 2013;27(3):391-404. PMID: 24238695; https://doi.org/10.1016/j.berh.2013.07.008.

Parodi A, Caproni M, Cardinali C, et al. Clinical, histological and immunopathological features of 58 patients with subacute cutaneous lupus erythematosus. A review by the Italian group of immunodermatology. Dermatology. 2000;200(1):6-10. PMID: 10681606;https://doi.org/10.1159/000018307.

Niebel D, Braegelmann C, Bieber T, Wenzel J. Vitiligo-like depigmentation subsequent to subacute cutaneous lupus erythematosus and hydroxychloroquine treatment. J Dtsch Dermatol Ges. 2020;18(12):1470-3. PMID: 32783375; https://doi.org/10.1111/ddg.14221.

Pelka K, Stec-Polak M, Wojas-Pelc A, Pastuszczak M. Prevalence of antimitochondrial antibodies in subacute cutaneous lupus erythematosus. Int J Dermatol. 2021;60(1):88-92. PMID: 33017043; https://doi.org/10.1111/ijd.15225.

Guicciardi F, Atzori L, Marzano AV, et al. Are there distinct clinical and pathological features distinguishing idiopathic from drug-induced subacute cutaneous lupus erythematosus? A European retrospective multicenter study. J Am Acad Dermatol. 2019;81(2):403-11. PMID: 30763648; https://doi.org/10.1016/j.jaad.2019.02.009.

Chong BF, Song J, Olsen NJ. Determining risk factors for developing systemic lupus erythematosus in patients with discoid lupus erythematosus. Br J Dermatol. 2012;166(1):29-35. PMID: 21910708; https://doi.org/10.1111/j.1365-2133.2011.10610.x.

Callen JP. Systemic lupus erythematosus in patients with chronic cutaneous (discoid) lupus erythematosus. Clinical and laboratory findings in seventeen patients. J Am Acad Dermatol. 1985;12(2 Pt 1):278-88. PMID: 3871800; https://doi.org/10.1016/s0190-9622(85)80036-0.

Merola JF, Prystowsky SD, Iversen C, et al. Association of discoid lupus erythematosus with other clinical manifestations among patients with systemic lupus erythematosus. J Am Acad Dermatol. 2013;69(1):19-24. PMID: 23541758; https://doi.org/10.1016/j.jaad.2013.02.010.

Pons-Estel GJ, Aspey LD, Bao G, et al. Early discoid lupus erythematosus protects against renal disease in patients with systemic lupus erythematosus: longitudinal data from a large Latin American cohort. Lupus. 2017;26(1):73-83. PMID: 27230554; https://doi.org/10.1177/0961203316651740.

Prenner J, Kelley K, Elkeeb D, Onajin O. Hypertrophic Discoid Lupus Erythematosus of the Vulva Mimicking Lichen Simplex Chronicus: A Case Report and Review of the Literature. Am J Dermatopathol. 2020;42(3):191-5. PMID: 31725484; https://doi.org/10.1097/dad.0000000000001549.

Daldon PE, Macedo de Souza E, Cintra ML. Hypertrophic lupus erythematosus: a clinicopathological study of 14 cases. J Cutan Pathol. 2003;30(7):443-8. PMID: 12859742; https://doi.org/10.1034/j.1600-0560.2003.00082.x.

Rangel LK, Villa-Ruiz C, Lo K, et al. Clinical Characteristics of Lupus Erythematosus Panniculitis/Profundus: A Retrospective Review of 61 Patients. JAMA Dermatol. 2020;156(11):1264-6. PMID: 32876656; https://doi.org/10.1001/jamadermatol.2020.2797.

González-Cruz C, Aparicio Español G, Ferrer Fàbrega B, et al. Lupus panniculitis: Clinicopathological features of a series of 12 patients. Med Clin (Barc). 2018;151(11):444-9. PMID: 30154008; https://doi.org/10.1016/j.medcli.2018.06.024.

Juczynska K, Wozniacka A, Waszczykowska E, Zebrowska A. Lupus erythematosus panniculitis resistant to standard treatment, complicated with macrophage activation syndrome. Postepy Dermatol Alergol. 2017;34(3):281-3. PMID: 28670262; https://doi.org/10.5114/ada.2017.67852.

Kuhn A, Richter-Hintz D, Oslislo C, et al. Lupus erythematosus tumidus − a neglected subset of cutaneous Lupus erythematosus: report of 40 cases. Arch Dermatol. 2000;136(8):1033-41. PMID: 10926740; https://doi.org/10.1001/archderm.136.8.1033.

Kuhn A, Bein D, Bonsmann G. The 100th anniversary of lupus erythematosus tumidus. Autoimmun Rev. 2009;8(6):441-8. PMID: 19162244; https://doi.org/10.1016/j.autrev.2008.12.010.

Hedrich CM, Fiebig B, Hauck FH, et al. Chilblain lupus erythematosus − a review of literature. Clin Rheumatol. 2008;27(8):949-54. PMID: 18543054; https://doi.org/10.1007/s10067-008-0942-9.

Viguier M, Pinquier L, Cavelier-Balloy B, et al. Clinical and histopathologic features and immunologic variables in patients with severe chilblains. A study of the relationship to lupus erythematosus. Medicine (Baltimore). 2001;80(3):180-8. PMID: 11388094; https://doi.org/10.1097/00005792-200105000-00004.

Kuhn A, Wenzel J, Bijl M. Lupus erythematosus revisited. Semin Immunopathol. 2016;38(1):97-112. PMID: 26637330; https://doi.org/10.1007/s00281-015-0550-0.

Ramos-Casals M, Nardi N, Lagrutta M, et al. Vasculitis in systemic lupus erythematosus: prevalence and clinical characteristics in 670 patients. Medicine (Baltimore). 2006;85(2):95-104. PMID: 16609348; https://doi.org/10.1097/01.md.0000216817.35937.70.

Cutolo M, Melsens K, Wijnant S, et al. Nailfold capillaroscopy in systemic lupus erythematosus: A systematic review and critical appraisal. Autoimmun Rev. 2018;17(4):344-52. PMID: 29427827;https://doi.org/10.1016/j.autrev.2017.11.025.

Gusdorf L, Bessis D, Lipsker D. Lupus erythematosus and neutrophilic urticarial dermatosis: a retrospective study of 7 patients. Medicine (Baltimore). 2014;93(29):e351. PMID: 25546692; https://doi.org/10.1097/md.0000000000000351.

Blake SC, Daniel BS. Cutaneous lupus erythematosus: A review of the literature. Int J Womens Dermatol. 2019;5(5):320-9. PMID: 31909151; https://doi.org/10.1016/j.ijwd.2019.07.004.

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Publicado

2021-04-12

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1.
Souza B de C e, Sanches JA. Manifestações cutâneas no lúpus eritematoso: o que o clínico precisa saber. Diagn. tratamento. [Internet]. 12º de abril de 2021 [citado 30º de outubro de 2026];26(2):65-72. Disponível em: https://periodicosapm.emnuvens.com.br/rdt/article/view/187

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Dermatologia