Application Guidelines Systemic Lupus Erythematosus

Specific History

Onset of Cutaneous Manifestations

If a malar rash is present at onset, it usually appears abruptly. Photosensitivity can be present but is not as prominent a feature in SLE as in cutaneous lupus erythematosus. Although skin lesions occur in 80% of SLE patients during the course of their disease, they are a presenting sign in only about 13%. Joint and other visceral symptoms predominate. Cutaneous lesions are nevertheless important because they constitute four of the 11 criteria used by the American Rheumatism Association to establish a diagnosis of SLE. The four defining cutaneous signs that can be present at onset are the following:

1. Fixed malar rash.

2. Photosensitivity.

3. Scarring discoid lesions.

4. Nasal or oropharyngeal ulcerations.

Cutaneous symptoms may occur at any point in the course of SLE. Skin manifestations in SLE are quite variable when compared to other cutaneous forms, and wax and wane with disease activity. The overall breakdown of cutaneous involvement in SLE is as follows:

1. Lesions typical of SLE: 50%.

2. Lesions more typical of SCLE: 15 to 20%.

3. Lesions more typical of DLE: 10 to 15%.

4. No cutaneous involvement: 20%.

Evolution of Disease Process

The course of SLE is so variable that there is no set pattern for the cutaneous lesions. Skin lesions of vascular origin may reflect widespread vascular injury in other organs. Onset or exacerbation of skin lesions in a patient with SLE often signals disease activity and should initiate a reassessment of lab parameters and current therapy.

Evolution of Skin Lesions

There are no consistent history findings characterizing the cutaneous manifestations of SLE.

Provoking Factors

Solar exposure is a common exacerbating factor for SLE and is reported in 30 to 75% of cases. The true incidence appears to be about 60%. A substantial number of patients seem to flare with extrinsic emotional or physical stress. There is a very extensive list of medications that have been reported to trigger SLE, exacerbate established SLE, or cause an SLE-like syndrome. Whenever possible, these should be avoided in patients with any form of LE.

Self-Medication

Self-medication is a problem in SLE mainly if patients indulge in the use of medications not specifically prescribed for them that exacerbate their disease.

Supplemental Review From General History

1. Patients with skin lesions that could be cutaneous manifestations of suspected SLE should have a comprehensive review of systems directed at symptoms of SLE.

2. Patients with established SLE who develop cutaneous manifestations consistent with LE should have a comprehensive re-evaluation of their SLE to determine if an exacerbation is occurring.

How To Deal With Rosacea and Eczema

How To Deal With Rosacea and Eczema

Rosacea and Eczema are two skin conditions that are fairly commonly found throughout the world. Each of them is characterized by different features, and can be both discomfiting as well as result in undesirable appearance features. In a nutshell, theyre problems that many would want to deal with.

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