Lupus PanniculitisLupus

 

 

Erythematosus Profundus

 

Lupus panniculitis is a chronic recurrent panniculitis that is more frequent in women than men. It is a mild variant of lupus erythematosus, and most patients show subcutaneous nodules as the only clinical manifestation of the disease.The lesions exhibit a predilection for the face, shoulders, upper arms, back, and buttocks, areas infrequently involved in other forms of panniculitis .

In rare instances, lesions of lupus panniculitis have been described in the subcutaneous fat of the breast (“lupus mastitis”), orbital fat, and periparotid fat tissue. An isomorphic phenomenon is frequently seen in patients with lupus panniculitis; subcutaneous erythematous nodules often develop or recur at the sites of trauma, injection, and biopsy.

 

 

LUPUS PANNICULITIS AT A GLANCE

Clinical

·         Erythematous nodules at the face, shoulders, upper arms, and buttocks

·         Persistent areas of lipoatrophy on regressed lesions

Histopathology

·         Only 20 percent to 30 percent of the patients with lupus panniculitis show features of discoid lupus erythematosus at the dermal-epidermal junction.

·         Mostly lobular panniculitis without vasculitis.

·         Inflammatory infiltrate predominantly composed of lymphocytes and plasma cells.

·         Often, lymphoid follicles with germinal centers.

·         Sclerotic collagen bundles at subcutaneous septa.

·         Hyaline necrosis and atrophy of the entire fat lobule in late-stage lesions.

Treatment

·         Corticosteroids under occlusion or in intralesional injections

·         Short oral courses of corticosteroids or hydroxychloroquine

·         Dapsone