Lupus - Dermatology and aesthetics

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Dermatology and aesthetics

Dermatology and aesthetics

Lupus

Chronic lupus erythematosus Lupus tuberculosis
  • Chronic lupus erythematosus
    • How it manifests itself
    • How to make the diagnosis
    • How it manifests itself
    • Diagnosis
    • How to cure it
  • Tuberculous lupus

Chronic lupus erythematosus

Chronic lupus erythematosus is a dermatosis that affects adults, especially women, after continuous and frequent sun exposure. It is also known as discoid lupus and consists of a rash that creates a kind of mask on the face. This disorder, which is related to systemic lupus erythematosus (an inflammatory disease of autoimmune origin), usually constitutes its first manifestation.

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How it manifests itself

The typical manifestation of this pathology is the formation of red skin lesions covered with crusts. These lesions, which cause intense itching, in the initial phase appear as plaques of modest size, which can sometimes have small dilated vessels; subsequently, however, there is an excessive increase in the stratum corneum of the skin, or hyperkeratosis, which can be of varying magnitude. The lesions are localized in a more or less symmetrical way on the nose, cheeks, ears, forehead and chin, up to sometimes touching the scalp (which causes hair loss) and even the oral mucous membranes, manifesting itself in this case, with a characteristic whitish border on the lips and red plaques inside the cheeks.

Sometimes lupus can extend to the point of causing obvious and unsightly lesions.

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How to make the diagnosis

A clinical examination of the lesions is required; after doing a skin biopsy, it is possible to perform a histological examination of the tissues, which is able to reveal cellular anomalies between the dermis and the epidermis.

The disease does not evolve in a single moment, but progresses in successive waves, which are usually caused by new exposures to the sun.

How to cure it

To treat lupus erythematosus it is necessary to take locally-acting dermocorticosteroids, to be applied by massaging the affected area or by bandaging. Very thickened lesions can be treated with cryosurgery or with the carbon dioxide laser. Many times, however, a single treatment is not enough and general therapy is necessary, which is based on the oral administration of antimalarials or, if these prove to be insufficient, of sulphones, retinoids and thalidomide.

In order to avoid the appearance of chronic lupus erythematosus, it is important not to expose yourself to the sun and always protect yourself from the sun's rays by using creams with total protection.

Systemic lupus erythematosus

Systemic lupus erythematosus (SLE) is an autoimmune inflammatory disease that affects many organs. It is part of systemic diseases (known in the past as connective tissue or collagenosis) and affects women in particular, especially those between 20 and 30 years of age. The factors at the origin of this pathology are manifold but, among these, what has a greater weight is certainly the genetic predisposition: it occurs more frequently, in fact, in subjects carrying the HLA alleles (Human-Leucocyte Antigen, human leukocyte antigen) DR2 and DR3 and in those suffering from congenital deficiency of the C2 or C4 fractions of the complement (i.e. the enzyme system involved in the immune response through the destruction of antigens).

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How it manifests itself

The signs of this pathology vary greatly from one patient to another. The general manifestations, present during the crisis of the disease, consist of fever, loss of appetite and weight loss. Joint manifestations are observed in 90% of patients (acute, subacute or chronic arthritis, or simple joint pain), while in 5% of cases even osteonecrosis (bone necrosis) develops.

The skin manifestations are manifold: erythema of the butterfly or mask face (to cover the upper part of the face), typical lesions of chronic lupus erythematosus (red plaques with crusts), vasculitis, urticaria, sensitivity to light, hair loss, type lesions pernio erythema, increase or decrease in pigmentation. Renal manifestations (glomerulonephritis) are observed in about 50% of patients and sometimes evolve towards renal failure. Renal biopsy is often helpful in clarifying the type and severity of renal engagement. Also the nervous system can be involved with numerous and protean manifestations: convulsive crisis, psychosis, paralysis, migraine, behavior disorders. Furthermore, cardiovascular disorders (pericarditis, myocarditis, endocarditis, arterial or venous thrombosis, hypertension), respiratory (pleurisy) and hematological (leukopenia, thrombocytopenia, hemolytic anemia or hypertrophy of the lymph nodes, increase in spleen volume) can be observed. Pregnancy and the postpartum period favor access to the disease. Spontaneous abortions are frequent.

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Diagnosis

To make the diagnosis of SLE we rely on the association of clinical manifestations (extremely variable: they can range from some skin lesions to severe and generalized involvement) and bioimmunological anomalies, such as the presence of anti-nuclear antibodies (directed against the cell nucleus), anti-DNA antibodies or reduced plasma levels of the complement fractions C3 and C4.

Sometimes antibodies (antiphospholipids) are found to be directed against clotting factors, which predispose to thrombosis and spontaneous abortions. Biopsy (of skin lesions and healthy skin) and renal biopsy are also used. The evolution is slow, in most cases unpredictable, and can last even 20-30 years. It proceeds spontaneously with attacks interspersed with periods of complete remission, of variable duration (from many months to many years).

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How to cure it

If this condition is diagnosed in a subject, treatment should be immediate. Therapies vary from case to case, depending on the symptoms that occur from time to time, but in any case, for all those suffering from systemic lupus erythematosus, the indication of absolute rest during attacks applies; it is also important to adequately protect yourself from sunlight.

As for the benign forms, they must be treated through the administration of non-steroidal anti-inflammatories or with acetylsalicylic acid, together with synthetic antimalarials. Sometimes a short corticotherapy is necessary.

The most serious forms, that is, those that severely affect the central nervous system or the kidneys, must be treated with high doses of corticosteroids, which sometimes must be associated with immunosuppressants. If the kidneys are affected by the injuries, kidney failure occurs, which must be treated by hemodialysis and, in the most serious cases, through a kidney transplant.

The pregnant woman with SLE needs continuous monitoring. It is good to underline that today the progress in the therapeutic field has been significant and have greatly increased the chances of recovery.

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