Discuss the skin changes of lupus erythematosus. Skin changes occur very frequently in lupus erythematosus (LE) and are second in frequency only to musculoskeletal complaints in this condition, occurring in about 85% of patients. It is useful to classify the eruptions seen in LE as to their possible diagnostic and prognostic significance. Skin lesions that are diagnostic of LE have been called lupus-specific eruptions. Skin biopsies of these lesions show characteristic histopathologic changes of cutaneous LE. Further classification of the lupus-specific eruptions into subtypes of cutaneous LE is also useful, as some lesions of cutaneous LE are more strongly associated with systemic lupus erythematosus. Lupus patients also develop many skin changes that are not specific for LE, termed lupus-nonspecific eruptions (Table 22-1). These eruptions do not help to establish a diagnosis of LE, but they may still be very important to note, as specific systemic findings may be associated with them. For example, cutaneous lesions of palpable purpura in a patient with LE are not lupus-specific, that is, such lesions may be seen in patients who do not have LE; however, they may be associated with vasculitic lesions of the kidney or central nervous system (CNS), and thus they have significance in the evaluation and treatment of lupus. Walling HW, Sontheimer RD: Cutaneous lupus erythematosus: issues in diagnosis and treatment, Am J Clin Dermatol 10:365–381, 2009.
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