Clinical Application Questions

A 35-year-old woman seeks help regarding a progressive skin eruption that began on the ears and facial skin late in the previous summer. The lesions stabilized during the winter months but rapidly progressed with the return of warm, sunny weather. Physical examination reveals a scaling dermatitis with discrete and confluent plaques. Some plaques have a depressed center and scarring. Telangectasia, hypopigmentation, and hyperpig-mentation are evident. The rash is asymmetric on the face and ears but is symmetrically distributed over the V of the chest, dorsal arms, and forearms with sharp limitation at the collar and short-sleeve protection line.

1. What is the most likely diagnosis: localized discoid lupus erythematosus (DLE), disseminated DLE, subacute cutaneous LE (SCLE), or systemic LE (SLE)?

2. What other findings on physical exam would be helpful in distinguishing one form of lupus from another?

3. What additional supplemental historical data would help to distinguish one form of lupus from another?

4. History reveals an unexplained episode of pleurisy 4 years ago. What supporting laboratory data are indicated?

5. If laboratory parameters are consistent with a diagnosis of SLE with discoid skin lesions, what are your treatment options?

6. If laboratory parameters are consistent with a diagnosis of disseminated DLE, what are your treatment options?

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