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****** DATA-MÉDICOS **********
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LUPUS ERITEMATOSO DISCOIDEO
DISCOID LUPUS ERYTTHEMATOSUS
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****** DERMAGIC-EXPRESS No.49 ******* 
****** 05 MAYO DE 1.999 *********** 
05 MAY 1.999
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EDITORIAL ESPAÑOL:
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Hola amigos de la red, DERMAGIC de nuevo con ustedes,,, el tema de hoy,,,LUPUS ERITEMATOSO DISCOIDEO, patología interesante por el simple hecho, que puede permanecer como tal durante muchos años (crónico), o ser el comienzo o anuncio de otras enfermedades como el Lupus Eritematoso Sistémico.

Espero que estas 61 referencias sean bastante ilustrativas.

En el attach una lámina ilustrativa del tema. Lupus discoideo crónico en cara, oreja, hombro y cuero cabelludo.

Saludos a TODOS !!!


PRÓXIMAS EDICIONES: * DERMATOMIOSITIS. * ESCLEROSIS SISTÉMICA PROGRESIVA, * LUPUS ERITEMATOSO SISTÉMICO 


Dr. José Lapenta R.,,,


EDITORIAL ENGLISH:
=====================
Hello friends of the net, DERMAGIC again with you, today's topic, DISCOID LUPUS ERYTTHEMATOSUS, interesting pathology for the simple fact that can remain as such during many years (chronic), or to be the beginning or announcement of other illnesses like the Systemic Lupus Erythematosus.

I hope these 61 references will be quite illustrative.

In the attach an illustrative sheet of the topic: Discoid lupus Erythematosus chronicus: face, ear, shoulder and scalp.

NEXT EDITIONS: * DERMATOMYOSITIS. * SYSTEMIC SCLEROSIS (SCLERODERMA) * SYSTEMIC LUPUS ERYTHEMATOSUS 

Greetings to ALL, !!

Dr. José Lapenta R.,,


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DERMAGIC/EXPRESS(49)
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LUPUS ERITEMATOSO DISCOIDEO / DISCOID LUPUS ERYTHEMATOSUS 
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1.) [Treatment of discoid lupus erythematosus with sulfasalazine: 11 cases] 
2.) Serologic and clinical features of patients with discoid lupus erythematosus: relationship of antibodies to single-stranded deoxyribonucleic acid and of other antinuclear antibody subsets to clinical manifestations. 
3.) An unusual ocular manifestation of discoid lupus erythematosus. 
4.) Immunohistochemical detection of proliferation and differentiation in discoid lupus erythematosus. 
5.) Squamous cell carcinoma of the skin in black patients with discoid lupus erythematosus. 
6.) The expression of C3b receptors in the differentiation of discoid lupus
erythematosus and systemic lupus erythematosus. 
7.) [Successful treatment of chronic discoid lupus erythematosus with argon laser] 
8.) Discoid lupus erythematosus presenting as asymmetric posterior blepharitis. 
9.) Squamous-cell carcinoma of the scalp arising in lesions of discoid lupus erythematosus. 
10.) Resistant discoid lupus erythematosus of palms and soles: successful treatment with azathioprine. 
11.) Autoantibodies to evolutionarily conserved epitopes of enolase in a patient with discoid lupus erythematosus. 
12.) Keratin and involucrin expression in discoid lupus erythematosus and lichen planus. 
13.) Defective degradation of bacterial DNA by phagocytes from patients with systemic and discoid lupus erythematosus. 
14.) [Comparative immunofluorescence study of actinic keratosis and chronic discoid lupus erythematosus] 
15.) Vitronectin colocalizes with Ig deposits and C9 neoantigen in discoid lupus erythematosus and dermatitis herpetiformis, but not in bullous pemphigoid. 
16.) A comparison of the dermal lymphoid infiltrates in discoid lupus erythematosus and Jessner's lymphocytic infiltrate of the skin using the monoclonal antibody Leu 8. 
17.) T-cell subsets in lesions of systemic and discoid lupus erythematosus. 
18.) A comparative immunohistochemical study of lichen planus and discoid lupus erythematosus. 
19.) Enhanced normal tissue response to radiation in a patient with discoid lupus erythematosus. 
20.) Retinitis pigmentosa and discoid lupus erythematosus. 
21.) Discoid lupus keratitis. 
22.) Acetylator polymorphism in discoid lupus erythematosus. 
23.) Hereditary deficiency of C5 in association with discoid lupus erythematosus. 
24.) Squamous cell carcinoma of the lip developing in discoid lupus erythematosus. 
25.) [Oral discoid lupus erythematosus. Diagnostic considerations apropos of a case] 
26.) Markers in cutaneous lupus erythematosus indicating systemic involvement. A multicenter study on 296 patients.
27.) NAT2 genotyping and efficacy of sulfasalazine in patients with chronic discoid lupus erythematosus.
28.) ARA and EADV criteria for classification of systemic lupus erythematosus in patients with cutaneous lupus erythematosus.
29.) Chronic discoid lupus erythematosus in Thailand: direct immunofluorescence study.Kulthanan K; Roongphiboolsopit P; Chanjanakijskul S; Kullavanijaya P
30.) Chronic discoid lupus erythematosus: an immunopathological and electron microscopic study.
31.) Squamous cell carcinoma of the lip developing in discoid lupus erythematosus.
32.) Childhood discoid lupus erythematosus.
33.) Warts and lupus erythematosus.
34.) Systemic sclerosis (scleroderma) associated with discoid lupus erythematosus.
35.) Vitamin E and discoid lupus erythematosus.
36.) Clinical, histologic, and immunofluorescent distinctions between subacute cutaneous lupus erythematosus and discoid lupus erythematosus.
37.) Scarring alopecia in discoid lupus erythematosus.
38.) Cutaneous lupus erythematosus in India: immunofluorescence profile [see comments]
39.) Chilblain lupus erythematosus: report of 15 cases [see comments]
40.) Sweat gland abnormalities in lichenoid dermatosis.
41.) The progressive systemic sclerosis/systemic lupus overlap: an unusual clinical progression.
42.) Safety and efficacy of a broad-spectrum sunscreen in patients with discoid or subacute cutaneous lupus erythematosus.
43.) Hereditary deficiency of C5 in association with discoid lupus erythematosus.
44.) Response of discoid and subacute cutaneous lupus erythematosus to recombinant interferon alpha 2a.
45.) Recombinant interferon alpha 2a is effective in the treatment of discoid and subacute cutaneous lupus erythematosus.
46.) Experimental reproduction of skin lesions in lupus erythematosus by UVA and UVB radiation [see comments]
47.) Histopathologic comparison of the subsets of lupus erythematosus [see comments]
48.) Chronic cutaneous lupus erythematosus.
49.) Rowell's syndrome. Report of a case.
50.) Expression of lymphocyte activation markers in benign cutaneous T cell infiltrates. Discoid lupus erythematosus versus lichen ruber planus.
51.) [Congenital ischemic onychodystrophy (Iso-Kikuchi syndrome) and chronic lupus 
52.) Evaluation of lymphocyte activation in skin lesions of patients with mixed connective tissue disease and discoid lupus erythematodes.
53.) Autofluorescence of clofazimine in discoid lupus erythematosus.
54.) A family survey of lupus erythematosus. 1. Heritability.
55.) A comparison of the dermal lymphoid infiltrates in discoid lupus erythematosus and Jessner's lymphocytic infiltrate of the skin using the monoclonal antibody Leu 8.
56.) Lupus profundus in children: treatment with hydroxychloroquine.
57.) The reliability of immunofluorescence and histopathology in the diagnosis of discoid lupus erythematosus and lichen planus.
58.) Immunopathology of cutaneous human lupus erythematosus defined by murine monoclonal antibodies.
59.) HLA genotypes in a family with a case of homozygous C2 deficiency and discoid lupus erythematosus.
60.) Laser treatment of discoid lupus (case report).
61.) Serologic and clinical features of patients with discoid lupus erythematosus: relationship of antibodies to single-stranded deoxyribonucleic acid and of other antinuclear antibody subsets to clinical manifestations.
62.) Squamous cell carcinoma of the lip developing in discoid lupus erythematosus.
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1.) [Treatment of discoid lupus erythematosus with sulfasalazine: 11 cases] 
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Author 
Delaporte E; Catteau b; Sabbagh N; Gosselin P; Breuillard F; Doutre MS; Broly F; Piette F; Bergoend H 
Address 
Service de Dermatologie A, H^opital Claude-Haried, CHRU, Lille. 
Source 
Ann Dermatol Venereol, 124(2):151-6 1997 

Abstract 

INTRODUCTION: Antimalaria agents and thalidomide are two reference drugs for discoid lupus erythematosus. In non-responders or after secondary resistance or contraindications, there are a number of alternative therapeutics which are less effective and more toxic. We therefore conducted an open study in patients with discoid lupus erythematosus treated with sulfasalazine.

PATIENTS AND METHODS: Seven men and four women (mean age 40 years) with severe discoid lupus erythematosus (mean duration of disease 14 years) were treated with sulfasalazine (2 g/d). This treatment was initiated after a previous failure or contraindication of antimalarial drugs or thalidomide. The acetylation phenotype was predicted in all patients with N-acetyltransferase 2 genotyping. Genome DNA was tested for mutations causing an N-acetyltransferase deficiency. Homozygous individuals or those with heterozygous composites for the tested mutations were predicted slow acetylators and those with a homozygous or heterozygous genotype for an allele carrying a normal sequence at the mutation sites were predicted rapid acetylators.

RESULTS: We had 7 complete responses, 1 partial response and 3 failures. Mean delay to efficacy was 7 weeks, longer for lesions involving the scalp (4 to 5 months). Six of the 8 responders were given sulfasalazine exclusively. The effect was suspensive and dose-dependent; the minimal effective dose was 1.5 g/d. Excepting light sensitization requiring discontinuation, there were no clinically significant side effects. Neutropenia occurred in one patient and moderate and transient live enzyme movements did not require treatment withdrawal. The only immunoallergic side effect (light sensitization) observed occurred in a slow acetylator. All responders except one were rapid acetylators.

DISCUSSION: Salazosulfapyridine, or sulfasalazine, is composed of a derivative of 5-aminosalicylic acid and a sulfamide fraction, sulfapyridine. It is only marginally used in dermatology except for psoriasis. Its efficacy in chronic lupus erythematosus has been reported in one case. We confirmed the role of this compound in the treatment of chronic lupus erythematosus. The rare observations of induced lupus and development of antinuclear antibodies are not a contraindication, but require close regular clinical and biological surveillance. The potential risk is that possible hypersensitivity could lead to reserving sulfasalazine for severe resistant chronic lupus erythematosus after failure with antimalarials and thalidomide. Nevertheless, our study demonstrates that the slow acetylator phenotype predicts immunoallergic events, as observed by other authors, and would be a factor predicting nonresponse. If these results are confirmed by other studies, it would be possible to propose sulfasalazine as a treatment for discoid lupus erythematosus in rapid acetylators. 

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2.) Serologic and clinical features of patients with discoid lupus erythematosus: relationship of antibodies to single-stranded deoxyribonucleic acid and of other antinuclear antibody subsets to clinical manifestations. 
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Author 
Callen JP; Fowler JF; Kulick KB 
Source 
J Am Acad Dermatol, 13(5 Pt 1):748-55 1985 Nov 

Abstract 

Serologic and clinical data were obtained from forty patients with discoid lupus erythematosus in 1982. Clinical disease was characterized by quality, extent, severity, activity, photosensitivity, and systemic manifestations. The patient's sera were examined for the presence of antinuclear, anti-Ro and anti-La, anti-ribonucleoprotein and anti-Sm, anti-single-stranded deoxyribonucleic acid (ssDNA), and antinative DNA antibodies. In late 1984, thirty-three patients had follow-up clinical examinations.

On the initial evaluation the patients with positive antinuclear antibody (ANA) findings were clinically characterized by a significantly higher incidence of photosensitivity and arthritis, an elevated erythrocyte sedimentation rate, and cutaneous lesions of subacute cutaneous lupus erythematosus. The activity and extent of disease in 1982 did not correlate with the presence of ANA. Elevated levels of ssDNA antibodies were present in seven of the forty patients (significantly greater than control subjects; (p less than 0.005) and correlated with widespread, active discoid lupus erythematosus, an elevated erythrocyte sedimentation rate, and a slightly greater risk of systemic lupus erythematosus in 1982.

At the 2-year follow-up examination, thirteen of the seventeen patients with a positive ANA had active clinical cutaneous disease, and ten of the sixteen patients with negative ANA findings had continued activity (not statistically significant). However, all seven patients with elevated ssDNA antibody levels had continued activity, and disease progression had occurred in three. Thus the presence of ssDNA seems to correlate strongly with active, progressive lupus erythematosus. The presence of antibody abnormalities in patients with discoid lupus erythematosus correlates with clinical disease and provides more support for the theory linking discoid lupus erythematosus to systemic lupus erythematosus as part of a continuum. 

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3.) An unusual ocular manifestation of discoid lupus erythematosus. 
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Author 
Foster RE; Lowder CY; Meisler DM; Valenzuela R; McMahon JT; Camisa C 
Address 
Department of Ophthalmology, Cleveland Clinic Foundation, OH 44195. 
Source 
Cleve Clin J Med, 61(3):232-7 1994 May-Jun 

Abstract 

BACKGROUND: Discoid lupus erythematosus is a chronic skin disease characterized by well-demarcated papules and plaques. Mucous membrane changes are common; however, conjunctival involvement is unusual. We report a case of unilateral, chronic, isolated discoid lupus erythematosus of the conjunctiva.

OBSERVATIONS: A 32-year-old man presented for evaluation of chronic conjunctivitis of the right eye that had persisted for 9 years. A biopsy of the bulbar conjunctiva revealed a mixed mononuclear cellular infiltrate distributed along the epithelial basement membrane zone and around the stromal blood vessels. Immunohistopathologic examination revealed a diffuse, granular pattern of fluorescence corresponding to immunoglobulins and complement components along the epithelial basement membrane zone and in the walls of the stromal blood vessels. Electron microscopy demonstrated changes in the epithelial basal lamina consistent with discoid lupus erythematosus, including areas that were multilayered. Immunoelectron microscopy identified sub-basal lamina deposits of immunoglobulin G.

CONCLUSIONS: Discoid lupus erythematosus should be a suspected cause of chronic conjunctival inflammation; the diagnosis is substantiated by immunopathologic and ultrastructural studies. 

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4.) Immunohistochemical detection of proliferation and differentiation in discoid lupus erythematosus. 
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Author 
de Jong EM; van Erp PE; Ruiter DJ; van de Kerkhof PC 
Address 
Department of Dermatology, University Hospital Nijmegen, The Netherlands. 
Source 
J Am Acad Dermatol, 25(6 Pt 1):1032-8 1991 Dec 

Abstract 

Discoid lupus erythematosus lesions show hyperkeratosis and atrophy, which may reflect abnormal epidermal proliferation, differentiation, or both. In this investigation, markers for epidermal proliferation, differentiation and inflammation were studied in cutaneous lesions of discoid lupus erythematosus.

 Frozen sections of biopsy specimens from 20 patients were examined immunohistochemically regarding Ki-67 staining and keratin 16 expression (parameters for proliferation), and the expression of keratin 10, involucrin, and filaggrin (parameters for differentiation).

The inflammatory infiltrate was characterized with the use of antibodies against T lymphocytes, monocytes/macrophages, and Langerhans cells. With these markers, epidermal proliferation was found to be increased in discoid lupus erythematosus. Keratin 10 expression, a marker for early differentiation, showed the pattern of normal skin. Involucrin and filaggrin, markers for terminal differentiation, were expressed already in the lower part of the stratum spinosum, whereas in normal skin these markers were restricted to the stratum granulosum and the upper layers of the stratum spinosum, and the stratum granulosum and stratum corneum, respectively. Infiltrate analysis revealed the well-established picture.

We conclude that in cutaneous lesions of discoid lupus erythematosus, hyperproliferation is combined with normal early differentiation and premature terminal differentiation of keratinocytes. 

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5.) Squamous cell carcinoma of the skin in black patients with discoid lupus erythematosus. 
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Author 
Caruso WR; Stewart ML; Nanda VK; Quismorio FP Jr 
Source 
J Rheumatol, 14(1):156-9 1987 Feb 

Abstract 

Skin cancer is relatively uncommon among black individuals. Squamous cell carcinoma occurred in a scar of chronic discoid lupus erythematosus in a black patient. A review of 7 previously reported cases of squamous cell carcinoma in blacks with chronic discoid lupus erythematosus indicates a tendency of the cancer to metastasize. Sun exposure of the hypopigmented lesions of chronic discoid lupus and possibly other factors predispose to cancer of the skin. Poorly healing skin lesions in chronic discoid lupus should arouse suspicion of malignant change. 

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6.) The expression of C3b receptors in the differentiation of discoid lupus erythematosus and systemic lupus erythematosus. 
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Author 
Tausk F; Harpster E; Gigli I 
Address 
Division of Dermatology, University of California, San Diego School of Medicine. 
Source 
Arthritis Rheum, 33(6):888-92 1990 Jun 

Abstract 

We studied the expression of the C3b receptor, CR1, on erythrocytes (E-CR1) of patients who, in spite of having mild systemic symptoms, were diagnosed as having discoid lupus erythematosus and followed accordingly. We found that E-CR1 was markedly reduced in these patients, similar to that seen in patients with systemic disease. In contrast, those patients with completely asymptomatic discoid lupus erythematosus had the same expression of E-CR1 as the normal population. 

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7.) [Successful treatment of chronic discoid lupus erythematosus with argon laser] 
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Author 
N¨urnberg W; Algermissen B; Hermes B; Henz BM; Kolde G 
Address 
Hautklinik, Virchow-Klinikum, Humboldt-Universit¨at zu Berlin. 
Source 
Hautarzt, 47(10):767-70 1996 Oct 

Abstract 

We report on a patient with chronic discoid lupus erythematosus who was treated with argon-laser. The patient suffered from long-standing lesions and had been pretreated with various drugs; with no or slight improvement. After a few argon-laser applications, the treated skin lesions improved dramatically while the untreated lesional skin showed continuous disease activity. Histological and immunohistological investigations of biopsies from treated and untreated lesional skin suggest that endothelial mechanisms play a role in the generation and maintenance of discoid lesions in lupus erythematosus.

This is the first reported case of successful treatment of chronic discoid skin lesions of a lupus erythematosus patient with argon-laser. 

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8.) Discoid lupus erythematosus presenting as asymmetric posterior blepharitis. 
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Author 
Gloor P; Kim M; McNiff JM; Wolfley D 
Address 
Department of Ophthalmology and Visual Science, Yale University School of Medicine, New Haven, CT 06520-8061, USA. [email protected] 
Source 
Am J Ophthalmol, 124(5):707-9 1997 Nov 

Abstract 

PURPOSE: To describe the ophthalmic findings of patients with discoid lupus erythematosus.

METHOD: We describe two women who originally were thought to have asymmetric posterior blepharitis; however, the involved eyelid also had an erythematous, scaly cutaneous lesion.

RESULT: In both patients, histology and immunofluorescence studies performed on cutaneous biopsy specimens established the diagnosis of discoid lupus erythematosus.

CONCLUSIONS: It is important to diagnose discoid lupus of the eyelids because misdiagnosis can delay treatment and thus lead to deformities of the eyelid margin. Misdiagnosis can also lead to a complicated full-thickness eyelid biopsy and delay the diagnosis of systemic lupus erythematosus. 

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9.) Squamous-cell carcinoma of the scalp arising in lesions of discoid lupus erythematosus. 
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Author 
Sulica VI; Kao GF 
Address 
Division of Dermatology, Georgetown University Medical Center, Washington, D.C. 
Source 
Am J Dermatopathol, 10(2):137-41 1988 Apr 

Abstract 

Squamous-cell carcinoma may arise in scars of chronic discoid lupus erythematosus. Although there have been 19 cases reported previously, detailed histopathologic features of this entity have not been recorded. We report a patient with extensive chronic discoid lupus erythematosus involving the scalp with subsequent development of multiple squamous-cell carcinomas.

The tumors were locally aggressive with recurrences and invasion into the underlying skull and dura. The patient died of respiratory failure 4 1/2 years after initial surgical treatment. There was no clinical evidence of metastasis. Squamous carcinoma arising in discoid lupus erythematosus can be regarded as a low-grade carcinoma.

Although about 20% of patients developed local recurrences and metastasis developed in about 30%, fatality occurred in only two patients (10.5%). Pertinent literature is reviewed, and the histopathologic findings, differential diagnosis, and biologic behavior of this tumor are discussed. 

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10.) Resistant discoid lupus erythematosus of palms and soles: successful treatment with azathioprine. 
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Author 
Ashinoff R; Werth VP; Franks AG Jr 
Address 
Department of Dermatology, New York University Medical Center, NY 10016. 
Source 
J Am Acad Dermatol, 19(5 Pt 2):961-5 1988 Nov 

Abstract 

We present the case of two patients with an unusual form of discoid lupus erythematosus that was confined almost exclusively to the palms and soles. In both patients this form of discoid lupus erythematosus did not respond to conventional therapies, which included topical steroids, intralesional steroids, prednisone, quinacrine hydrochloride, hydroxychloroquine sulfate, colchicine, and dapsone. Both patients were then treated with azathioprine.

One patient dramatically improved with azathioprine, worsened each time the azathioprine was stopped or reduced, and responded again to the reinstitution of therapy.

The other patient began taking azathioprine 8 months ago and has also experienced relief of her symptoms. These cases suggest that discoid lupus erythematosus principally involving the palms and soles is difficult to treat with conventional medication and that azathioprine, which appears to be useful, should be tried after the failure of other therapies. 

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11.) Autoantibodies to evolutionarily conserved epitopes of enolase in a patient with discoid lupus erythematosus. 
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Author 
Gitlits VM; Sentry JW; Matthew ML; Smith AI; Toh BH 
Address 
Department of Pathology and Immunology, Monash Medical School, Prahran, Victoria, Australia. 
Source 
Immunology, 92(3):362-8 1997 Nov 

Abstract 

Although the pathology of discoid lupus erythematosus is well documented the causative agents are not known. Here, we report the identity of the target antigen of an autoantibody present in high titre in the serum of a patient with discoid lupus erythematosus.

We have demonstrated that the antigen is enolase; first, because it has properties consistent with this glycolytic enzyme (47,000 MW, cytosolic localization and ubiquitous tissue distribution). Secondly, limited amino acid sequence determination after trypsin digestion shows identity with alpha-enolase. Finally, the autoimmune serum immunoblots rabbit and yeast enolase and predominantly one isoelectric form of enolase (PI approximately 6.1). These results indicate that the reactive autoepitopes are highly conserved from man to yeast.

The results also suggest that the autoantibodies are most reactive to the alpha-isoform of enolase, although it is possible that they may also be reactive with gamma-enolase, and have least reactivity to beta-enolase. The anti-enolase autoantibodies belong to the immunoglobulin G1 (IgG1) isotype.

This is the first report of IgG1 autoantibodies to evolutionarily conserved autoepitopes of enolase in the serum of a patient with discoid lupus erythematosus. Previous reports of autoantibodies to enolase have suggested associations with autoimmune polyglandular syndrome type I and cancer-associated retinopathy.

This report and an earlier report of what is likely to be enolase autoantibodies in two patients without systemic disease suggest that enolase autoantibodies have a broad association and are not restricted to any particular disease. 

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12.) Keratin and involucrin expression in discoid lupus erythematosus and lichen planus. 
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Author 
Ichikawa E; Watanabe S; Takahashi H 
Address 
Division of Dermatology, Doai Memorial Hospital, Tokyo, Japan. 
Source 
Arch Dermatol Res, 289(9):519-26 1997 Aug 

Abstract 

In the present study, keratin and involucrin expression were studied in cutaneous lesions of discoid lupus erythematosus and lichen planus in order to gain a better understanding of the abnormal differentiation or maturation of the epidermal cells in these dermatoses.

Ten specimens each from discoid lupus erythematosus and lichen planus were analyzed by immunohistochemical techniques, using a panel of monoclonal antikeratin antibodies and polyclonal anti-involucrin antibody, and five specimens each were analyzed by one- and two-dimensional gel electrophoresis and immunoblot analysis using three antikeratin antibodies. No significant difference was found between the dermatoses.

The expression of differentiation-specific keratins showed a similar pattern to that in normal epidermis, and involucrin was expressed even in the lower part of the stratum spinosum. Keratins 6 and 16, which are characteristic markers of hyperproliferative states, and keratin 17 were detected in nonhyperproliferative and atrophic epidermis with hydropic degeneration and inflammatory infiltrates in the dermis.

These results suggest that expression of keratins 6, 16 and 17 in discoid lupus erythematosus and lichen planus may reflect a wound healing response to the damage to the basal cell layer, or may be under the control of cytokines produced by infiltrating inflammatory cells in the dermis. 

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13.) Defective degradation of bacterial DNA by phagocytes from patients with systemic and discoid lupus erythematosus. 
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Author 
Roberts PJ; Isenberg DA; Segal AW 
Address 
Department of Haematology, Faculty of Clinical Sciences, University College, London, UK. 
Source 
Clin Exp Immunol, 69(1):68-78 1987 Jul 

Abstract 

The digestion of bacterial DNA by peripheral blood monocytes was impaired both in patients with systemic lupus erythematosus (SLE) and discoid lupus erythematosus (DLE). The monocytes of these patients had both a small quantitative defect in the solubilization of DNA and a marked qualitative defect in the extent to which this DNA was degraded. In addition, neutrophils from patients with SLE released significantly less high molecular-weight DNA than control cells. Digestion of bacterial RNA and protein by phagocytes was not defective in either disease. The reduced digestion of DNA by phagocytes resulted in concomitantly larger amounts of high molecular-weight DNA remaining in these cells. Such sequestration of DNA may contribute to the persistence of fairly large DNA fragments in the tissue of patients with lupus erythematosus.  Language 

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14.) [Comparative immunofluorescence study of actinic keratosis and chronic discoid lupus erythematosus] 
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Author 
Gruschwitz M; Keller J 
Address 
Dermatologische Universit¨ats-Klinik Erlangen. 
Source 
Z Hautkr, 62(22):1585-95 1987 Nov 15 

Abstract 

Regarding systemic (SLE) and chronic discoid lupus erythematosus (CDLE), the diagnostic value of the lupus band test ist generally accepted. In the literature, however, there are but few obligatory criteria concerning the definition of a positive lupus band. In order to illustrate the influence of sunlight on the evolution of junctional deposits of immunoglobulins, we examplarily studied actinic keratosis (AK) as a chronic light-dependent dermatosis. The junctional deposits in AK were qualitatively and quantitatively compared with the lupus band typical for CDLE. In CDLE we mostly found more distinct band-like junctional deposits of immunoglobulins and complements. Light-dependent, non-specific junctional patterns of immunofluorescence similar to LE, therefore, require clear morphological criteria of immunohistology. 

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15.) Vitronectin colocalizes with Ig deposits and C9 neoantigen in discoid lupus erythematosus and dermatitis herpetiformis, but not in bullous pemphigoid. 
=====================================================================
Author 
Dahlb¨ack K; L¨ofberg H; Dahlb¨ack B 
Address 
Department of Dermatology, University of Lund, Sweden. 
Source 
Br J Dermatol, 120(6):725-33 1989 Jun 

Abstract 

C9 neoantigen immunoreactivity has been found to colocalize with C3 immunoreactivity at the dermal-epidermal junction zone (DEZ) in skin specimens from patients with bullous pemphigoid, lupus erythematosus and dermatitis herpetiformis. The present study was designed to elucidate whether the C9 neoantigen immunoreactivity represents deposition of membrane attack complexes or non-lytic SC5b-9 complexes.

Skin specimens from 11 patients with pemphigoid, five patients with discoid lupus erythematosus and from nine patients with dermatitis herpetiformis were studied with immunofluorescence using both monoclonal and polyclonal antibodies against C9 neoantigen and against vitronectin (S-protein), an inhibitor to the membrane attack complex of complement.

Specimens from the pemphigoid patients demonstrated C9 neoantigen reactivity along the DEZ without detectable colocalized vitronectin. This suggests deposition of membrane attack complexes in the pemphigoid lesions. Immunoreactivity of both C9 neoantigen and vitronectin was detected in the DEZ in specimens of discoid lupus erythematosus and in the tips of dermal papillae in specimens of dermatitis herpetiformis. The combined presence of C9 neoantigen- and vitronectin immunoreactivity may indicate deposition of C9 as part of the non-lytic SC5b-9 complex.

The finding reported here of differential deposition of vitronectin and C9 in different diseases indicates that the presence of C9 neoantigen immunoreactivity in tissue per se does not represent the deposition of membrane attack complexes, but that it may also be C9 deposited as part of the nonlytic SC5b-9 complex. 

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16.) A comparison of the dermal lymphoid infiltrates in discoid lupus erythematosus and Jessner's lymphocytic infiltrate of the skin using the monoclonal antibody Leu 8. 
=====================================================================
Author 
Ashworth J; Turbitt M; MacKie R 
Source 
J Cutan Pathol, 14(4):198-201 1987 Aug 

Abstract 

Jessners lymphocytic infiltration of the skin (14 cases) and discoid lupus erythematosus (13 cases) were studied and the lymphoid infiltrates in the dermis were compared in the two conditions, using a standard immunoperoxidase technique. Mouse monoclonal antibodies were used to identify T helper lymphocytes, T suppressor lymphocytes and, using the antibody Leu 8, "immunoregulatory lymphocytes . It was shown that the proportions of Leu 8 positive cells was significantly different in the two conditions.

The average percentage of Leu 8 positive lymphocytes in the dermal infiltrate found in the cases of Jessner's was 65% (range 40-80%) whereas the average percentage in the cases of discoid LE was 15% (range 2-30%). This observation is further evidence that Jessner's lymphocytic infiltration and chronic discoid lupus erythematosus should be regarded as separate entities. 

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17.) T-cell subsets in lesions of systemic and discoid lupus erythematosus. 
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Author 
Kohchiyama A; Oka D; Ueki H 
Source 
J Cutan Pathol, 12(6):493-9 1985 Dec 

Abstract 

In 6 patients with untreated systemic lupus erythematosus (SLE) in the progressive stage, and in 6 with discoid lupus erythematosus (DLE), an analysis of inflammatory infiltrates was performed in situ using the avidin-biotin-peroxidase complex (ABC) method with monoclonal antibodies. In all patients, over 75% of the infiltrates reacted with the pan T-cell antibody OKT3, but only sporadically with that of B-cell OKB7.

In addition, a large number of the infiltrates were OKIal-positive, indicating that they were in an activated state. Many OKT8-positive cells were seen infiltrating the epidermis especially in the vicinity of basal keratinocytes. Staining for T-cell subsets revealed that the proportion of OKT8-positive cells (suppressor/cytotoxic) was from 2 to 3 fold higher than that of OKT4-positive cells (helper/inducer) in lesions of SLE.

On the contrary, in DLE, a predominance of OKT4-positive cells (the OKT4/OKT8 ratio was from 1:1 to 3:1) was observed. Thus, our results provide further evidence that these 2 main types of LE show quite contrary findings on immunohistochemical analysis of T-cell subsets, and that besides the humoral immune mechanism, the cell-mediated immune mechanism may be involved in the pathogenesis of these disorders. 

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18.) A comparative immunohistochemical study of lichen planus and discoid lupus erythematosus. 
=====================================================================
Author 
Lee MS; Wilkinson B; Doyle JA; Kossard S 
Address 
Skin and Cancer Foundation Australia, Darlinghurst, New South Wales, Australia. 
Source 
Australas J Dermatol, 37(4):188-92 1996 Nov 

Abstract 

A comparative immunohistochemical study was performed on skin biopsies from 10 patients with lichen planus and 10 patients with discoid lupus erythematosus (DLE). A panel of antibodies against T lymphocytes (UCHL-1, OPD-4, CD8, CD43), B lymphocytes (L-26), granulocytes (Leu-M1), activation markers (Ki-1, LN-3), macrophages, fibroblasts and dendritic cells (FXIIIa, S-100, Mac-387, KP-1, vimentin), endothelial cells (CD34), and epithelial cells (epithelial membrane antigen) was employed using a peroxidase-anti-peroxidase technique.

The recently released CD8 antiserum required microwave antigen retrieval of formalin-fixed, paraffin-embedded tissue to label lymphocytes. The results showed many similarities in the lymphocyte subsets and macrophages between lichen planus and discoid lupus erythematosus. The most important differences between the two conditions were statistically significant increases in the number of S-100+ cells in the epidermis and dermis, FXIIIa+ cells in the dermis and CD34+ vessels within the inflammatory infiltrate in lichen planus. 

=====================================================================
19.) Enhanced normal tissue response to radiation in a patient with discoid lupus erythematosus. 
=====================================================================
Author 
Rathmell AJ; Taylor RE 
Address 
Department of Radiotherapy and Oncology, Cookridge Hospital, Leeds, UK. 
Source 
Clin Oncol (R Coll Radiol), 4(5):331-2 1992 Sep 

Abstract 

We report the case of a patient with discoid lupus erythematosus who developed a severe skin reaction whilst undergoing mantle irradiation for non-Hodgkin's lymphoma. Widespread moist desquamation occurred after a skin dose of only 17 Gy and was associated with an abscopal response outside the treatment area. The case illustrates the need for extreme caution when administering radiotherapy to patients with discoid or systemic lupus erythematosus. 

=====================================================================
20.) Retinitis pigmentosa and discoid lupus erythematosus. 
=====================================================================
Author 
Desatnik H; Ashkenazi I; Regenbogen L 
Address 
Goldschleger Eye Institute, Chaim Sheba Medical Center, Sackler School of Medicine, Tel-Hashomer, Israel. 
Source 
Metab Pediatr Syst Ophthalmol, 15(1-3):9-11 1992 

Abstract 

A 41 year old male is presented who suffers from both advanced retinitis pigmentosa and active discoid lupus erthematosus. A possible association between the two pigmenting disorders is discussed as well as the treatment of the discoid lupus with potentially retinotoxic hydroxychloroquine. 

=====================================================================
21.) Discoid lupus keratitis. 
=====================================================================
Author 
Raizman MB; Baum J 
Address 
Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston 02114. 
Source 
Arch Ophthalmol, 107(4):545-7 1989 Apr 

Abstract 

Two patients with long-standing discoid lupus erythematosus developed acute, unilateral, corneal stromal infiltration and edema. No evidence of infection was found, and both responded rapidly to topical corticosteroid therapy. To our knowledge, only one case of stromal keratitis associated with discoid lupus erythematosus has been published previously. We describe the first cases, to our knowledge, in which a satisfactory response to corticosteroid therapy is demonstrated. 

=====================================================================
22.) Acetylator polymorphism in discoid lupus erythematosus. 
=====================================================================
Author 
Ladero JM; Jim´enez LC; Fern´andez MJ; Robledo A 
Address 
Department of Medicine, Hospital Universitario San Carlos, Facultad de Medicina, Universidad Complutense, Madrid, Spain. 
Source 
Eur J Clin Pharmacol, 34(3):307-8 1988 

Abstract 

Acetylator phenotype was determined, using sulphamethazine, in 37 patients with histologically confirmed discoid lupus erythematosus, who were free from visceral damage, and in 157 normal control subjects. Twenty patients (54%) and 90 control subjects (57.4%) were slow acetylators (p not significant). Acetylator polymorphism appears not to be related to the risk of developing pure cutaneous discoid lupus erythematosus. 

=====================================================================
23.) Hereditary deficiency of C5 in association with discoid lupus erythematosus. 
=====================================================================
Author 
Asghar SS; Venneker GT; van Meegen M; Meinardi MM; Hulsmans RF; de Waal LP 
Address 
Department of Dermatology, Academic Medical Center, University of Amsterdam, The Netherlands. 
Source 
J Am Acad Dermatol, 24(2 Pt 2):376-8 1991 Feb 

Abstract 

A 29-year-old woman with discoid lupus erythematosus had undetectable classic pathway complement activity. Hypocomplementemia was due to selective deficiency of C5. One of her children was also deficient. To our knowledge this is the first documented case of an association between discoid lupus erythematosus and C5 deficiency. 

=====================================================================
24.) Squamous cell carcinoma of the lip developing in discoid lupus erythematosus. 
=====================================================================
Author 
Handlers JP; Abrams AM; Aberle AM; Auyong T; Melrose RJ 
Source 
Oral Surg Oral Med Oral Pathol, 60(4):382-6 1985 Oct 

Abstract 

Since the substitution of steroids and antimalarials for irradiation in the treatment of discoid lupus erythematosus, squamous cell carcinoma arising in discoid lupus erythematosus is thought by some to be an uncommon occurrence. A review of the recent literature (subsequent to 1945) revealed fifteen cases, of which seven occurred in the lips.

In one of twelve of the cases a history of irradiation was documented. In three other cases, there was no evidence of its use. We report an additional case of squamous cell carcinoma occurring in the lower lip of a 24-year-old black woman in the absence of radiation therapy. A review of the literature and a discussion of possible predisposing factors are presented. 

=====================================================================
25.) [Oral discoid lupus erythematosus. Diagnostic considerations apropos of a case] 
=====================================================================
Author 
Bermejo Fenoll A; Rom´an Maci´a P; Bag´an Sebasti´an JV; Gonz´alez L´opez-Briones L 
Source 
Rev Stomatol Chir Maxillofac, 86(3):156-64 1985 

Abstract 

The study and presentation of a typical case of discoid lupus erythematosus with oral lesions in a 30-years old woman, without visceral manifestations at present, was the motive for a revision and updating of the concepts of etiology, differential diagnosis, treatment and prognosis of this disease.

The authors emphasize the importance of the clinical and evolving aspect of the lesions, long-term development, as well as the response to treatment (an antimalarial synthesis, applied systematically and infiltrates with betamethasone solution) in order to reach valid diagnostic conclusions. It is important in the anatomopathological study to include the atrophic zones of the central portion of the discoid lesion. 

=====================================================================
26.) Markers in cutaneous lupus erythematosus indicating systemic involvement. A  multicenter study on 296 patients.
=====================================================================
Tebbe B; Mansmann U; Wollina U; Auer-Grumbach P; Licht-Mbalyohere A; Arensmeier M;  Orfanos CE
Department of Dermatology, University Medical Center Benjamin Franklin, The Free  University of Berlin, Germany.
Acta Derm Venereol (NORWAY) Jul 1997 77 (4) p305-8 ISSN: 0001-5555
Language: ENGLISH
Document Type: JOURNAL ARTICLE; MULTICENTER STUDY 
Journal Announcement: 9711

Subfile: INDEX MEDICUS

Lupus erythematosus (LE) is an autoimmune disorder, involving the skin and/or other  internal organs. As cutaneous variants, chronic discoid LE (CDLE) and subacute  cutaneous LE (SCLE) usually have a better prognosis, however, involvement of internal  organs with transition into systemic disease may occur.

The aim of this study was to  assess the significance of some clinical and laboratory criteria that could serve as  markers for early recognition of systemic involvement in cutaneous LE. Three hundred  and seventy-nine patients with LE, seen in five cooperating Departments of  Dermatology during the years 1989-1994, were documented by electronic data processing  according to a common protocol.

Two hundred and forty-five of these patients had  cutaneous LE (CDLE or SCLE), and 51 had systemic LE (SLE) and were included in this  study. Forty-nine patients with either CDLE/SCLE or SLE were not evaluated because  of incomplete documentation; also, 34 patients suffered from other LE subsets and  were likewise excluded from the evaluation. Multivariate statistical analysis was  used to assess the value of seven selected variables for distinguishing between the  CDLE/SCLE and SLE groups:

ESR, titers of antinuclear antibodies, anti-dsDNA- antibodies, photosensitivity, presence of arthralgias, recurrent headaches and signs  of nephropathy. Univariate and multivariate analysis of the obtained data showed  that signs of nephropathy (proteinuria, hematuria) was the variable with the highest  statistical relevance for distinguishing between patients with cutaneous (CDLE/SCLE)  and with systemic LE (SLE) in all statistical models tested, followed by the presence  of arthralgias and of high ANA titers (> or =1:320).

In contrast, low ANA titers as  well as anti-dsDNA antibodies showed little or no statistical relevance as a  criterion for distinction. It seems, therefore, that cutaneous LE patients showing  signs of nephropathy, presence of arthralgias and elevated ANA titers (> or =1:320)  should be carefully monitored, because they may be at risk of developing systemic LE  involvement.

=====================================================================
27.) NAT2 genotyping and efficacy of sulfasalazine in patients with chronic discoid  lupus erythematosus.
=====================================================================
Sabbagh N; Delaporte E; Marez D; Lo-Guidice JM; Piette F; Broly F
Laboratoire de Biochimie et Biologie Moleculaire de l'hopital Calmette,  Universitaire de Lille, France.
Pharmacogenetics (ENGLAND) Apr 1997 7 (2) p131-5 ISSN: 0960-314X
Language: ENGLISH
Document Type: JOURNAL ARTICLE 
Journal Announcement: 9710

Subfile: INDEX MEDICUS

Sulfasalazine is an effective agent for chronic discoid lupus erythematosus (CDLE)  but the response to treatment is considerably variable between patients and is also  unpredictable. The reason for this might relate to differences in metabolism of the  drug which is extensively acetylated by the polymorphic enzyme N-acetyltransferase 2  (NAT2). To test this possibility, the N-acetylation phenotype of eleven patients  with CDLE and treated by standard doses of sulfasalazine was retrospectively  determined by genotyping.

A clear-cut difference in the outcome of treatment was  observed according to whether the patients were slow acetylators (SA) or rapid  acetylators (RA). Eight out of 11 patients responded to treatment with a complete or  marked remission of the disease. Seven of them were RA. The three other patients  who did not respond at all to the drug were SA. In addition, SA seem to be more  prone to toxic events. These findings strongly suggest that the genetic polymorphism  of NAT2 is responsible for differences in the response to sulfasalazine in patients  with CDLE. Therefore, candidates for sulfasalazine therapy should be genotyped to  identify those patients who might benefit from the drug.

=====================================================================
28.) ARA and EADV criteria for classification of systemic lupus erythematosus in  patients with cutaneous lupus erythematosus.
=====================================================================
Parodi A; Rebora A
Department of Dermatology, University of Genoa, Italy.
Dermatology (SWITZERLAND) 1997 194 (3) p217-20 ISSN: 1018-8665
Language: ENGLISH
Document Type: JOURNAL ARTICLE 
Journal Announcement: 9710

Subfile: INDEX MEDICUS

OBJECTIVE: To verify (1) how many patients with cutaneous lupus erythematosus (CLE)  fulfill 4 or more American Rheumatism Association (ARA) and European Academy of  Dermatology and Venereology (EADV) criteria for classification of systemic lupus  erythematosus (SLE); (2) which criteria are mostly fulfilled; (3) the severity of the  disease in patients fulfilling criteria; (4) how many patients with systemic  involvement fail to fulfill 4 ARA and EADV criteria.

METHODS: We studied 207  patients with chronic and subacute CLE, classified according to ARA and EADV criteria. 

RESULTS: Twenty-four patients with localized discoid (L-DLE; 21.8%), 22 with  disseminated discoid (D-DLE; 30.5%) and 7 with subacute CLE (SCLE; 28%) had 4 or more  ARA criteria. With EADV criteria, these figures fell to 7 (6.4%), 7 (9.7%) and 6  (24%), respectively. Only 3 L-DLE (2.7%), 5 D-DLE (6.9%) and 3 SCLE cases (12%)  defined as SLE by ARA criteria and 1, 3 and 3, respectively, by EADV criteria had a  renal or neurological disorder, hemolytic anemia and/or thrombocytopenia, vasculitis  or serositis. ARA criteria did not classify 7 patients with a similar visceral  involvement, while EADV criteria failed in 11 patients.

CONCLUSION: In our patients,  ARA criteria showed a sensitivity of 88%, a specificity of 79%, a positive predictive  value of 56% and a negative predictive value of 96%. EADV criteria showed a  sensitivity of only 64%, but a specificity of 93%, a positive predictive value of 61%  and a negative predictive value of 94%. ARA criteria should not be used in CLE  patients as they are too sensitive, poorly specific and altogether misleading. EADV  criteria are more specific, but less sensitive.

=====================================================================
29.) Chronic discoid lupus erythematosus in Thailand: direct immunofluorescence study.
=====================================================================
Kulthanan K; Roongphiboolsopit P; Chanjanakijskul S; Kullavanijaya P
Institute of Dermatology, Bangkok, Thailand.
Int J Dermatol (UNITED STATES) Oct 1996 35 (10) p711-4 ISSN: 0011-9059
Language: ENGLISH
Document Type: JOURNAL ARTICLE 
Journal Announcement: 9704

Subfile: INDEX MEDICUS

BACKGROUND: Studies of chronic discoid lupus erythematosus (DLE) lesions by direct  immunofluorescence (DIF) were heterogeneous with respect to classes of  immunoglobulins and sites where these were deposited. Most of the studies were done  in the USA and European countries.

MATERIALS AND METHODS: To obtain representative  data from Asiatic countries, we analyzed the direct immunofluorescent abnormalities  of 100 DLE lesions in Thai patients who were diagnosed on the basis of clinical and  histologic criteria.

RESULTS: Granular deposits at the dermoepidermal junction (DEJ)  were detected in 90% of cases. The common immunoreactants at the DEJ were IgG (63%)  and IgM (47%). The deposits were usually combinations of various classes of  immunoglobulins, mostly IgG (53%) and IgM (41%). Deposits of IgG and IgM alone at  the DEJ were observed in 12% and 8%, respectively. Deposits at colloid bodies,  dermal blood vessel walls, and epidermal nuclei were sometimes also seen. 

CONCLUSIONS: The DIF test of skin biopsy specimens is diagnostically significant in  chronic DLE. Our study in Thai patients showed that the most common deposit was a  combination of various classes of immunoglobulins, mostly IgG and often IgM as well  as C3, and occurred at the DEJ of the involved area.

=====================================================================
30.) Chronic discoid lupus erythematosus: an immunopathological and electron microscopic study.
=====================================================================
Shahidullah M; Lee YS; Khor CJ; Ratnam KV
National Skin Centre, National University Hospital.
Ann Acad Med Singapore (SINGAPORE) Nov 1995 24 (6) p789-92 ISSN: 0304-4602
Language: ENGLISH
Document Type: JOURNAL ARTICLE 
JJournal Announcement: 9704

Subfile: INDEX MEDICUS

We studied 100 cases of chronic cutaneous discoid lupus erythematosus (DLE) to  evaluate the diagnostic sensitivity of immunoreactant deposition and its possible  role in basement membrane thickening. Histopathology was diagnostic in 71% of cases.  Sixty-two percent (41/66) of lesions with thickened and 50% (17/34) with normal  basement membrane had immunoreactant deposition.

Ultrastructural study of 6 cases (3  with and 3 without immunoreactant deposition) with thickened basement membrane all  showed reduplication of the lamina densa. Thickening of the basement membrane  appears to be contributed mainly by reduplication of the lamina densa rather than by  immunoreactant deposition.

The direct immunofluorescence (DIF) test of lesional skin  was positive in 58% of patients and was independent of duration of lesion, age and  sex. Light microscopy has greater diagnostic sensitivity in confirming DLE lesions  than DIF. Direct salt split skin technique did not increase DIF sensitivity. Scalp  lesions showed the highest frequency (83%) of immunoreactant deposition. As C1q was  the commonest immunoreactant found in our study, we suggest that it should be  routinely used when DIF is employed in the evaluation of DLE. DIF is especially  helpful in confirming cicatricial alopecia due to DLE.

=====================================================================br> 31.) Squamous cell carcinoma of the lip developing in discoid lupus erythematosus.
=====================================================================
SO - Oral Surg Oral Med Oral Pathol 1985 Oct;60(4):382-6
AU - Handlers JP; Abrams AM; Aberle AM; Auyong T; Melrose RJ
PPT - JOURNAL ARTICLE

AB - Since the substitution of steroids and antimalarials for irradiation in the treatment of discoid lupus erythematosus, squamous cell carcinoma arising in discoid lupus erythematosus is thought by some to be an uncommon occurrence. A review of the recent literature (subsequent to 1945) revealed fifteen cases, of which seven occurred in the lips. In one of twelve of the cases a history of irradiation was documented. In three other cases, there was no evidence of its use. We report an additional case of squamous cell carcinoma occurring in the lower lip of a 24-year-old black woman in the absence of radiation therapy. A review of the literature and a discussion of possible predisposing factors are presented.br>
=====================================================================
32.) Childhood discoid lupus erythematosus.
=====================================================================
SO - Arch Dermatol 1993 May;129(5):613-7
AU - George PM; Tunnessen WW Jr
PPT - JOURNAL ARTICLE; REVIEW (15 references); REVIEW OF REPORTED CASES

AB - BACKGROUND--Discoid lupus erythematosus (DLE) is uncommon in childhood. Less than 2% of patients with DLE develop the disease before 10 years of age.

OBSERVATIONS--We present eight cases of childhood DLE with onset before age 10 years: four black boys with cutaneous DLE, three black girls ages 7, 2, and 6 years at onset, who developed systemic lupus erythematosus at ages 12, 9, and 8 years, respectively, and a 10-year-old Hispanic boy who had a systemic flare at the age of 20 years.

CONCLUSIONS--A review of the 16 published cases of childhood DLE reveals that it is similar to its adult counterpart in its presentation and chronic course. However, several important differences are noted: a lack of female predominance, a low incidence of photosensitivity, and frequent progression to systemic lupus erythematosus at an early age. A discussion of the management of DLE in children is also presented.

=====================================================================br> 33.) Warts and lupus erythematosus.
=====================================================================
SO - Lupus 1993 Feb;2(1):21-3
AU - Yell JA; Burge SM
PPT - JOURNAL ARTICLE

AB - The human papilloma virus is implicated in causing several diseases, ranging from the common wart to malignancy. We describe a high prevalence of cutaneous warts in lupus erythematosus. The presence of warts did not correlate with the taking of immunosuppressive drugs. This observation suggests that there is a primary immunological defect among patients with lupus erythematosus.

We found this high rate among patients with discoid as well as systemic lupus erythematosus. We found no correlation between the prevalence of cutaneous warts and cervical dysplasia, or malignancy. Discoid lupus erythematosus is often considered to be a different disease from systemic lupus erythematosus, running a more benign course. The high prevalence of cutaneous warts in both conditions highlights yet another similarity between these two diseases.

=====================================================================br> 34.) Systemic sclerosis (scleroderma) associated with discoid lupus erythematosus.
=====================================================================
SO - Dermatology 1993;187(3):178-81
AU - Sasaki T; Nakajima H
PPT - JOURNAL ARTICLE

AB - Six patients with systemic sclerosis (SS) and discoid lupus erythematosus (DLE) were studied to determine whether such cases have some common clinical and laboratory findings. DLE preceded SS in all cases. Three patients had diffuse scleroderma with lung and esophagus involvements and the others limited scleroderma. Three patients had anti-topoisomerase-I and antiribonucleoprotein antibodies, 2 had either of them and the remaining anticentromere antibodies.

Four had DLE located on the scalp, leading to alopecia. The other 2 had DLE on the face and extremities. No case fulfilled criteria for systemic lupus erythematosus (SLE). The present cases with SS and DLE, but without SLE, indicate that this type of systemic-cutaneous collagen disease overlap does exist and may be not so rare.

=====================================================================br> 35.) Vitamin E and discoid lupus erythematosus.
=====================================================================
SO - Lupus 1992 Oct;1(5):303-5
AU - Yell JA; Burge S; Wojnarowska F
PPT - CLINICAL TRIAL; JOURNAL ARTICLE

AB - We treated seven patients with discoid lupus erythematosus (DLE) with Vitamin E in an oral dose of 400 mg three times per day for 12 weeks. All other systemic and topical treatments were discontinued 1 month before initiation of the trial. The drug was then stopped and follow-up continued for at least another 4 weeks.

 No patient showed clearing of lesions. The trial was conducted during summer, when DLE is likely to be most active. There was no deterioration in any patient. No side effects were noted.

=====================================================================br> 36.) Clinical, histologic, and immunofluorescent distinctions between subacute cutaneous lupus erythematosus and discoid lupus erythematosus.
=====================================================================
SO - J Invest Dermatol 1992 Sep;99(3):251-7
AU - David-Bajar KM; Bennion SD; De Spain JD; Golitz LE; Lee LA
PPT - JOURNAL ARTICLE

AB - Subacute cutaneous lupus erythematosus (SCLE) was originally described and distinguished from discoid lupus erythematosus (DLE) on the basis of clinical examination of the skin, but subsequent reports have questioned the concept of SCLE as a marker of a unique subset of LE patients. We classified 27 lupus patients, on the basis of cutaneous exam, as having discoid lupus skin lesions, subacute cutaneous skin lesions, or systemic lupus erythematosus (SLE) without DLE or SCLE lesions.

Clinical features most characteristic of SCLE rather than DLE were superficial, non-indurated, non-scarring lesions, and photosensitivity, with lack of induration being the single most helpful finding. Histologic examination of lesional skin showed a relatively sparse, superficial infiltrate in SCLE and a denser, deeper infiltrate in DLE. A distinctive pattern of staining with direct immunofluorescence, particulate epidermal IgG deposition, was found in seven of seven SCLE patients (all anti-Ro/SSA positive) and none of the other patients.

This distinctive pattern can be reproduced experimentally when anti-Ro/SSA autoantibodies are infused into human skin-grafted mice. Particulate dermal-epidermal junctional staining was the pattern seen in the patients who did not have SCLE. Clinically defining SCLE as a superficial inflammatory form of cutaneous lupus (i.e., considering lesions to be DLE if they are indurated) results in a meaningful segregation of SCLE and DLE patient groups. The epidermal IgG deposits unique to SCLE provide independent evidence that the clinical findings that were used to identify the patient groups actually identify distinctive cutaneous lupus subsets.

The observation that antibodies are present in a different location in the skin in SCLE than in DLE indicates that SCLE and DLE are likely to have different pathomechanisms.

=====================================================================br> 37.) Scarring alopecia in discoid lupus erythematosus.
=====================================================================
SO - Br J Dermatol 1992 Apr;126(4):307-14
AU - Wilson CL; Burge SM; Dean D; Dawber RP
PPT - JOURNAL ARTICLE

AB - The clinicopathological features of the scarring alopecia of discoid lupus erythematosus (DLE) were studied. Scarring alopecia was present in 34% of 89 patients with DLE and was associated with a prolonged disease course. More than half these patients had scalp involvement at the onset of the disease.

There was a significant reduction in size of sebaceous glands in affected scalp. Perifollicular lymphocytic inflammation was maximal around the mid-follicle at the level of the sebaceous gland, which seems to be an important functional level in the follicle.

There are changes in the expression of the matrix molecules, the proteoglycans, in the connective tissue sheath and the keratin intermediate filaments in the outer root sheath cells at this level in normal scalp and in diseased scalp. Loss of a population of mid-follicular stem cells may be important in the pathogenesis of scarring alopecia in DLE.

=====================================================================br> 38.) Cutaneous lupus erythematosus in India: immunofluorescence profile [see comments]
=====================================================================
CM - Comment in: Int J Dermatol 1993 Jan; 32(1):76
SO - Int J Dermatol 1992 Apr;31(4):265-9
AU - George R; Mathai R; Kurian S
PPT - JOURNAL ARTICLE

AB - The clinical profile and cutaneous lesions of 65 patients with lupus erythematosus (LE) are described. This included 28 discoid LE (13 disseminated, 15 localized), five subacute cutaneous LE, and 32 systemic LE. The need to recognize a pigmented macular form constituting 25% of discoid LE is emphasized. Increased incidence of involvement of the lower lip in discoid LE and pigmentation in systemic LE is noted. Lupus band test was found to be highly sensitive; it was positive for lesional skin of all untreated patients with subacute cutaneous LE and systemic LE, it was, however, not useful on nonlesional skin.br>
=====================================================================
39.) Chilblain lupus erythematosus: report of 15 cases [see comments]
=====================================================================
CM - Comment in: Dermatology 1992; 185(2):160
SO - Dermatology 1992;184(1):26-8
AU - Doutre MS; Beylot C; Beylot J; Pompougnac E; Royer P
PPT - JOURNAL ARTICLE

AB - In this retrospective study, the authors describe the clinical, histologic and laboratory features of 15 cases of chilblain or perniotic lupus. In winter, the patients (14 women, 1 man) develop chilblain-like lesions, chiefly in the toes (8 times) and fingers (11 times). Histologic features are identical to those of discoid lupus erythematosus. The damaged skin gives a positive fluorescent band test. Usually, these lesions occur in association with discoid lupus of the face. However, in 8 patients, they were the only cutaneous sign of lupus. This form of lupus can evolve to a systemic form, as was the case with 3 patients.br>
=====================================================================
40.) Sweat gland abnormalities in lichenoid dermatosis.
=====================================================================
SO - Histopathology 1991 Oct;19(4):345-9
AU - Akosa AB; Lampert IA
PPT - JOURNAL ARTICLE

AB - Lichenoid dermatosis is a pattern description of a variety of cutaneous lesions which primarily affect the dermoepidermal junction. Involvement of skin appendages has been restricted to hair follicles in lichen planopilaris and discoid lupus erythematosus.

Sweat gland involvement has not been described in the four common members of this group, namely, lichen planus, discoid lupus erythematosus, fixed drug eruptions and erythema multiforme, although structural abnormalities have been reported in graft-versus-host disease. In a detailed morphological study of 59 cases, including lichen planus (12), discoid lupus erythematosus (18), fixed drug eruption (14) and erythema multiforme (15), 78% (47/59) showed sweat, gland abnormalities.

The abnormalities included vacuolation of cell cytoplasm, with and without lymphocytic infiltration, apoptosis of basal cells and basal cell hyperplasia of the excretory ducts which predominantly affected the portion of the duct adjoining the acrosyringium. The portion of the duct close to the secretory gland was only involved in continuity and the secretory glands were unaffected.

These abnormalities of the sweat gland mostly constitute primary involvement by the disease process in contrast to structural abnormalities secondary to fibrosis.

=====================================================================br> 41.) The progressive systemic sclerosis/systemic lupus overlap: an unusual clinical progression.
=====================================================================
SO - Ann Rheum Dis 1991 May;50(5):323-7
AU - Asherson RA; Angus H; Mathews JA; Meyers O; Hughes GR
PPT - JOURNAL ARTICLE

AB - Three patients with the unusual combinations of discoid lupus, systemic lupus erythematosus (SLE), and progressive systemic sclerosis (PSS) are reported. The first patient developed PSS eight years after a diagnosis of discoid lupus had been made and this was complicated by myositis six years later. The second patient developed PSS more than 20 years after being diagnosed as having SLE.

The third patient developed SLE with predominant features of urticarial vasculitis six years after PSS. Mild myositis also ensued. There were no antibodies to U1RNP demonstrable in any of these patients. The clinical progression of SLE to PSS or vice versa in the absence of features of mixed connective tissue disease is distinctly uncommon.


=====================================================================br> 42.) Safety and efficacy of a broad-spectrum sunscreen in patients with discoid or subacute cutaneous lupus erythematosus.
=====================================================================
SO - Cutis 1991 Feb;47(2):130-2, 135-6
AU - Callen JP; Roth DE; McGrath C; Dromgoole SH
PPT - JOURNAL ARTICLE

AB - An eight-week, open-label study was conducted to test the efficacy, safety, and cosmetic acceptability of a broad-spectrum sunscreen in patients with discoid lupus erythematosus or subacute cutaneous lupus erythematosus. The sunscreen combined the ultraviolet A absorber avobenzone (Parsol 1789, Givaudan Corp) and the ultraviolet B absorber padimate O and had a sun protection factor greater than fifteen.

The overall clinical disease severity decreased from 2.7 (four point scale) at baseline to 1.7 after eight weeks (p = 0.005). Cutaneous signs and symptoms, including hyperpigmentation, papules, scaling, and erythema, were significantly less severe at the end of the study. The level of protection provided by the sunscreen was good to excellent in 54 percent of patients, and was judged to be superior or far superior to previously used sun protection factor-fifteen sunscreens in 77 percent of patients. Most patients found the sunscreen highly acceptable with respect to its cosmetic properties.

=====================================================================br> 43.) Hereditary deficiency of C5 in association with discoid lupus erythematosus.
=====================================================================
SO - J Am Acad Dermatol 1991 Feb;24(2 Pt 2):376-8
AU - Asghar SS; Venneker GT; van Meegen M; Meinardi MM; Hulsmans RF; de Waal LP
PPT - JOURNAL ARTICLE

AB - A 29-year-old woman with discoid lupus erythematosus had undetectable classic pathway complement activity. Hypocomplementemia was due to selective deficiency of C5. One of her children was also deficient. To our knowledge this is the first documented case of an association between discoid lupus erythematosus and C5 deficiency.br>
=====================================================================
44.) Response of discoid and subacute cutaneous lupus erythematosus to recombinant interferon alpha 2a.
=====================================================================
SO - J Invest Dermatol 1990 Dec;95(6 Suppl):142S-145S
AU - Nicolas JF; Thivolet J; Kanitakis J; Lyonnet S
PPT - JOURNAL ARTICLE

AB - Ten patients suffering from discoid lupus erythematosus (DLE) or subacute cutaneous lupus erythematosus (SCLE) were treated with interferon alpha 2a. A marked improvement or clearing of cutaneous lupus erythematosus lesions was observed in eight of them. However, the response to interferon was of short duration and within a few weeks after interferon withdrawal all patients who were improved or cleared relapsed.

This study suggests that interferon alpha 2a represents a new interesting approach in the treatment of DLE and SCLE. Ongoing trials will define the optimal treatment schedule for the maintenance of interferon-induced improvement of cutaneous lupus erythematosus.

=====================================================================br> 45.) Recombinant interferon alpha 2a is effective in the treatment of discoid and subacute cutaneous lupus erythematosus.
=====================================================================
SO - Br J Dermatol 1990 Mar;122(3):405-9
AU - Thivolet J; Nicolas JF; Kanitakis J; Lyonnet S; Chouvet B
PPT - CLINICAL TRIAL; JOURNAL ARTICLE

AB - Ten patients suffering from either discoid lupus erythematosus (DLE) or subacute cutaneous lupus erythematosus (SCLE) were treated with interferon alpha 2a. Eight received low or intermediate doses (18-45 x 10(6) U/week) for a short period of time (4-8 weeks), with marked improvement of skin lesions in six, an exacerbation in one patient and no change in the other. Two patients with SCLE received high doses (100-120 x 10(6) U/week) over 12 weeks, with complete clearing of the lesions in one and a marked improvement in the other.

The responses were of short duration and within a few weeks of stopping treatment all who had improved or cleared relapsed. The side-effects in all the patients were fever and a flu-like syndrome which necessitated a reduction of the dose in one case. In two patients there were increases in the liver enzyme levels, but no haematological toxicity was noted.

=====================================================================br> 46.) Experimental reproduction of skin lesions in lupus erythematosus by UVA and UVB radiation [see comments]
=====================================================================
CM - Comment in: J Am Acad Dermatol 1991 Mar; 24(3):515
SO - J Am Acad Dermatol 1990 Feb;22(2 Pt 1):181-7
AU - Lehmann P; Holzle E; Kind P; Goerz G; Plewig G
PPT - JOURNAL ARTICLE

AB - Sunlight is a well-established factor in the induction and exacerbation of lupus erythematosus. Although experimental reproduction of lupus erythematosus lesions with wavelengths shorter than 320 nm was demonstrated previously, the effect of wavelengths longer than 320 nm was not investigated adequately. In this study we show that the action spectrum of lupus erythematosus reaches into the UVA region. A total of 128 patients with lupus erythematosus underwent phototesting with the use of polychromatic UVB and long-wave UVA.

Subsets of the disease consisted of discoid lupus erythematosus (n = 86), subacute cutaneous lupus erythematosus (n = 22), and systemic lupus erythematosus (n = 20). Skin lesions clinically and histologically compatible with lupus erythematosus were induced in 64% of patients with subacute cutaneous lupus erythematosus, 42% of patients with discoid lupus erythematosus, and 25% of patients with systemic lupus erythematosus.

The action spectrum of the induced lesions was within the UVB range in 33% of patients, in the UVA range in 14%, and in the UVB and UVA range in 53%. In positive test reactions patchy dark erythema and urticarial plaques developed within a few days. In some patients typical discoid lesions persisted for months.

=====================================================================br> 47.) Histopathologic comparison of the subsets of lupus erythematosus [see comments]
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CM - Comment in: Arch Dermatol 1990 Dec; 126(12):1651
SO - Arch Dermatol 1990 Jan;126(1):52-5
AU - Jerdan MS; Hood AF; Moore GW; Callen JP
PPT - JOURNAL ARTICLE

AB - A recent study by Bangert et al suggests that there are quantitative histologic differences that distinguish discoid lupus erythematosus (DLE) and subacute cutaneous lupus erythematosus (SCLE). Utilizing criteria proposed by these authors, we examined 77 biopsy specimens from 63 patients with various forms of lupus erythematosus, but we were unable to predict the correct clinical subset.

Using the clinical diagnosis of DLE as a positive reference standard, the sensitivity and specificity for the overall pathologic diagnosis of DLE were 55% and 42%, respectively. Statistically significant histologic factors favoring the diagnosis of DLE over SCLE in the present study were pilosebaceous atrophy, hyperkeratosis, parakeratosis, basement membrane thickening around the follicles, subepidermal edema, and vascular ectasia. These histologic variables were entered into a forward stepwise multivariate regression analysis to determine distinct predictors of DLE vs SCLE.

This analysis showed that pilosebaceous atrophy was the only distinct significant predictor of DLE vs SCLE. These results suggest that the histologic differentiation of clinically defined DLE and SCLE cannot be established from the histologic features examined.

=====================================================================br> 48.) Chronic cutaneous lupus erythematosus.
=====================================================================
SO - Med Clin North Am 1989 Sep;73(5):1055-71
AU - Hymes SR; Jordon RE
PPT - JOURNAL ARTICLE; REVIEW (60 references); REVIEW, TUTORIAL

AB - Chronic cutaneous LE is a diverse disease, characterized by predominantly cutaneous disease with few systemic complications. Discoid lesions are commonly seen, but they are not specific for chronic cutaneous LE. These scarring and disfiguring changes are also present in neonatal LE, SLE, and complement deficiency LE. Because definitive diagnosis cannot be made by cutaneous examination alone, all patients should initially be evaluated for systemic disease.

 A small percentage of patients with chronic cutaneous LE will ultimately develop SLE, and therefore, patients should be re-evaluated periodically. The pathogenesis of the cutaneous lesions is not definitively known. There is suggestive evidence implicating T-cell mediated injury, especially in discoid LE. Antibody-dependent cellular cytotoxicity may also play a significant role in cellular damage in subacute cutaneous LE and neonatal LE, especially in the presence of anti-Ro antibody. Immunoglobulin deposition in association with membrane attack complex, has been associated with epidermal injury in some cases.

Treatment of chronic cutaneous LE is largely symptomatic and nonspecific, focusing on reduction of inflammation. Further knowledge of pathogenesis will, hopefully, provide for specific immunologic therapy.

=====================================================================br> 49.) Rowell's syndrome. Report of a case.
=====================================================================
SO - J Am Acad Dermatol 1989 Aug;21(2 Pt 2):374-7
AU - Parodi A; Drago EF; Varaldo G; Rebora A
PPT - JOURNAL ARTICLE; REVIEW (8 references); REVIEW, TUTORIAL

AB - We describe a patient with discoid lupus erythematosus who developed annular lesions of the thigh and chilblainlike lesions of the fingers matching those described in the original reports of Rowell's syndrome. The patient also had circulating anti-Ro(SS-A) antibodies whose similarity to the anti-Sj-T antibodies found in the original Rowell's syndrome cases has been recently claimed. A review of the literature suggests that most of the cases of Rowell's syndrome described thus far in fact may be cases of coincidental association of lupus erythematosus and erythema multiforme. br>
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50.) Expression of lymphocyte activation markers in benign cutaneous T cell infiltrates. Discoid lupus erythematosus versus lichen ruber planus.
=====================================================================
SO - Acta Derm Venereol 1989;69(4):292-5
AU - Sundqvist KG; Wanger L
PPT - JOURNAL ARTICLE

AB - The expression of lymphocyte activation markers (IL2 receptors, transferrin receptors and HLA-DR) was examined in cutaneous lymphoid infiltrates of 12 patients with lichen ruber planus (LP) and 10 individuals with discoid lupus erythematosus (DLE). The cell infiltrates in both conditions were generally of considerable size. The vast majority of the infiltrating cells were T cells.

The reactivity of the anti-IL2 receptor antibody used was confined to lymphocytes. In patients with LP 26 +/- 17% of the infiltrating cells were IL2 receptor positive, 20 +/- 8% carried transferrin receptors and greater than 90% HLA-DR. In patients with DLE less than 1% were IL2 receptor positive, less than 5% carried transferrin receptors and greater than 90% were HLA-DR positive. These data indicate that IL2 receptor expression distinguishes the infiltrating T-lymphocytes in LP and DLE, although in both conditions the vast majority of the infiltrating cells were activated as revealed by their expression of HLA-DR.

=====================================================================br> 51.) [Congenital ischemic onychodystrophy (Iso-Kikuchi syndrome) and chronic lupus erythematosus]
=====================================================================
SO - Hautarzt 1988 Nov;39(11):750-2
AU - Bittar EQ; Parra CA; Ledesma de Prieto G; Briggs E; Ortiz Baeza O
PPT - JOURNAL ARTICLE

AB - We report a patient with nail and bone disorders of the index and middle fingers (Iso and Kikuchi syndrome) associated with chronic discoid lupus erythematosus. Angiographic studies showed filiform arteries of the fingers and slow blood circulation. Since a vascular pathogenic mechanisms is probable, the designation "Congenital ischemic onychodystrophy" seems more suitable. The association with chronic discoid lupus erythematosus has not previously been reported.br>
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52.) Evaluation of lymphocyte activation in skin lesions of patients with mixed connective tissue disease and discoid lupus erythematodes.
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SO - Arch Dermatol Res 1988;280(1):1-4
AU - Bergroth V; Konttinen YT; Piirainen H; Johansson E; Nordstrom D; Malmstrom M
PPT - JOURNAL ARTICLE

AB - Biopsy specimens from mixed connective tissue disease (MCTD) and discoid lupus erythematodes (DLE) skin lesions were stained with monoclonal antibodies to differentiation and activation antigens. In addition, the blast cells were studied by combining autoradiography with immunoperoxidase staining. In both disease conditions most of the inflammatory cells in situ were positive for T11 antigen, the CD4/CD8 ratio being low.

 Only a few of the cells were pan-B positive B cells. The expression of various activation antigens did not differ significantly between MCTD and DLE biopsy specimens; the number of T9, Tac, and 4F2 antigen carrying cells was relatively low, whereas Ia-positive cells were more numerous. 3H-Thymidine incorporating T blasts comprised less than 1% of all inflammatory cells. T4 and T8 marker-carrying blast cells were present in about equal proportions. These findings suggest that Ia antigen-expressing T cells are important from the pathogenetic point of view in both MCTD and DLE.

Because the local proliferation of T cells was extremely low according to the lack of interleukin-2 receptor and OKT9 markers and 3H-thymidine incorporation, it seems probable that most of the T cells are recruited from the circulation to the site of the inflammation.

=====================================================================br> 53.) Autofluorescence of clofazimine in discoid lupus erythematosus.
=====================================================================
SO - J Am Acad Dermatol 1987 Nov;17(5 Pt 2):867-71
AU - Kossard S; Doherty E; McColl I; Ryman W
PPT - JOURNAL ARTICLE

AB - A 70-year-old woman developed dark reddish blue pigmentation in scarred areas of discoid lupus erythematosus after taking clofazimine intermittently over a period of 10 years. Although light microscopy of routinely processed tissue failed to define the cause of the pigment, fluorescent microscopy showed vivid red deposits concentrated around larger vessels within the dermis.

These deposits were shown to correspond to birefringent red clofazimine crystals on fresh frozen sections. Although the hyperpigmentation may clinically resemble melanin, biopsy specimens from our patient revealed a loss of melanin pigment in lesional skin, suggesting a primary role for clofazimine in producing the color changes observed.

=====================================================================br> 54.) A family survey of lupus erythematosus. 1. Heritability.
=====================================================================
SO - J Rheumatol 1987 Oct;14(5):913-21
AU - Lawrence JS; Martins CL; Drake GL
PPT - JOURNAL ARTICLE

AB - First degree relatives and spouses of 36 patients with systemic lupus erythematosus (SLE) and 37 with discoid lupus erythematosus (LE) were assessed using the ARA criteria. They were compared with relatives and spouses of patients with other rheumatic and related complaints. Definite SLE was present in 3.9% of relatives of SLE probands, 2.6% of discoid relatives and 0.3% of controls.

Discoid LE was diagnosed in 0.6% of SLE and 3.5% of discoid families compared with 0.5% of controls. None of the spouses of LE probands had SLE or discoid LE. The data gave the best fit for a polygenic inheritance with a heritability of 66 +/- 11% for SLE and 44 +/- 10% for discoid LE. Genetic factors are thus less important in SLE and discoid LE than in generalized osteoarthritis, spondylitis or gout with heritabilities of 90, 72 and 90%, respectively.

=====================================================================br> 55.) A comparison of the dermal lymphoid infiltrates in discoid lupus erythematosus and Jessner's lymphocytic infiltrate of the skin using the monoclonal antibody Leu 8.
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SO - J Cutan Pathol 1987 Aug;14(4):198-201
AU - Ashworth J; Turbitt M; MacKie R
PPT - JOURNAL ARTICLE

AB - Jessners lymphocytic infiltration of the skin (14 cases) and discoid lupus erythematosus (13 cases) were studied and the lymphoid infiltrates in the dermis were compared in the two conditions, using a standard immunoperoxidase technique. Mouse monoclonal antibodies were used to identify T helper lymphocytes, T suppressor lymphocytes and, using the antibody Leu 8, "immunoregulatory lymphocytes".

It was shown that the proportions of Leu 8 positive cells was significantly different in the two conditions. The average percentage of Leu 8 positive lymphocytes in the dermal infiltrate found in the cases of Jessner's was 65% (range 40-80%) whereas the average percentage in the cases of discoid LE was 15% (range 2-30%). This observation is further evidence that Jessner's lymphocytic infiltration and chronic discoid lupus erythematosus should be regarded as separate entities.

=====================================================================br> 56.) Lupus profundus in children: treatment with hydroxychloroquine.
=====================================================================
SO - J Am Acad Dermatol 1987 Apr;16(4):839-44
AU - Fox JN; Klapman MH; Rowe L
PPT - JOURNAL ARTICLE

AB - Discoid lupus erythematosus and lupus profundus, rare in children, are described in two young girls, one with onset at 3 1/2 years of age, the other at 8 years of age. Unusual nodules of the face that ultimately healed with atrophy and hyperpigmentation showed histologic and immunofluorescent confirmation of lupus erythematosus. These patients, the second and third in the English literature to be treated for childhood lupus profundus with antimalarials, responded successfully to hydroxychloroquine. No systemic involvement was found.br>
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57.) The reliability of immunofluorescence and histopathology in the diagnosis of discoid lupus erythematosus and lichen planus.
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SO - Br J Dermatol 1987 Feb;116(2):189-98
AU - Nieboer C
PPT - JOURNAL ARTICLE

AB - We have investigated the diagnostic reliability of the immunofluorescence (IF) technique and histopathology in discoid lupus erythematosus (DLE) and lichen planus (LP) and in diseases clinically resembling these (DLE-like and LP-like).

 In all cases of DLE and LP it was possible to establish the clinical diagnosis with one or both methods, when in initially negative cases the investigations were repeated on fresh biopsies. In DLE the diagnostic specificity of IF was greater than that of histopathology, and the diagnostic sensitivity of the results of both methods together was greater than that of the two methods separately. In LP the diagnostic specificity of both methods was maximal, but IF showed greater diagnostic sensitivity.

These differences were not statistically significant. The most important immunohistochemical feature for diagnosis by IF was the incidence and the morphological pattern of IgG along the epidermal basement membrane. This held true for differentiation between LP and DLE and also between DLE and DLE-like diseases. Combination of the results of IF and histopathology gave the most reliable results in DLE. In LP, IF was more reliable than histopathology.

=====================================================================br> 58.) Immunopathology of cutaneous human lupus erythematosus defined by murine monoclonal antibodies.
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SO - J Am Acad Dermatol 1986 Sep;15(3):474-81
AU - Andrews BS; Schenk A; Barr R; Friou G; Mirick G; Ross P
PPT - JOURNAL ARTICLE

AB - Skin biopsy specimens obtained from involved skin from sixteen patients with systemic and discoid lupus erythematosus were studied. Murine monoclonal antibodies with a biotin-avidin-horseradish peroxidase staining system were used.

The findings consisted of a marked reduction in the number of epidermal Langerhans cells defined by surface antigens, reduced HLA-DR (Ia-like) antigens on the surface of dermal capillary endothelium, and mononuclear cell infiltrates characterized by a predominance of helper T lymphocytes and an increase in the number of mononuclear phagocytic cells. B lymphocytes were rarely identified. The number of T lymphocytes within the dermis correlated inversely with both the number of HLA-DR-positive epidermal Langerhans cells (p less than 0.01) and the HLA-DR staining of dermal capillary endothelium (p less than 0.01).

These findings suggest that a T lymphocyte-mediated immune response associated with a reduction in Langerhans cells and capillary endothelium HLA-DR antigens is involved in the inflammatory process of lupus erythematosus skin.

=====================================================================br> 59.) HLA genotypes in a family with a case of homozygous C2 deficiency and discoid lupus erythematosus.
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SO - Acta Derm Venereol 1986;66(5):419-22
AU - Braathen LR; Bratlie A; Teisberg P
PPT - JOURNAL ARTICLE

AB - A fifty-year-old man with a history of recurrent bronchial and renal infections, and rheumatoid arthritis was admitted with a sunexposure-induced discoid lupus erythematosus. Complement levels and HLA typing of the patient and his family revealed a homozygous C2 deficiency in the patient and his HLA-identical healthy younger sister. The C2 deficiency gene was associated with HLA-A10, B18, DR2, C4A4B2, BfS on one chromosome and with HLA-A2, B7, DR2, C4A4B2, BfS on the other.br>
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60.) Laser treatment of discoid lupus (case report).
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SO - Lasers Surg Med 1986;6(1):12-5, 44-5
AU - Henderson DL; Odom JC
PPT - JOURNAL ARTICLE

AB - This is a case report of vaporization of the characteristic disfiguring plaques of discoid lupus erythematosus (DLE) with the carbon dioxide laser. This patient had a dramatic clinical and cosmetic improvement. It is suggested that the altered but not vaporized cells that remained were responsible for the retardation of the disease process.

=====================================================================br> 61.) Serologic and clinical features of patients with discoid lupus erythematosus: relationship of antibodies to single-stranded deoxyribonucleic acid and of other antinuclear antibody subsets to clinical manifestations.
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SO - J Am Acad Dermatol 1985 Nov;13(5 Pt 1):748-55
AU - Callen JP; Fowler JF; Kulick KB
PPT - JOURNAL ARTICLE

AB - Serologic and clinical data were obtained from forty patients with discoid lupus erythematosus in 1982. Clinical disease was characterized by quality, extent, severity, activity, photosensitivity, and systemic manifestations. The patient's sera were examined for the presence of antinuclear, anti-Ro and anti-La, anti-ribonucleoprotein and anti-Sm, anti-single-stranded deoxyribonucleic acid (ssDNA), and antinative DNA antibodies. In late 1984, thirty-three patients had follow-up clinical examinations.

On the initial evaluation the patients with positive antinuclear antibody (ANA) findings were clinically characterized by a significantly higher incidence of photosensitivity and arthritis, an elevated erythrocyte sedimentation rate, and cutaneous lesions of subacute cutaneous lupus erythematosus. The activity and extent of disease in 1982 did not correlate with the presence of ANA.

Elevated levels of ssDNA antibodies were present in seven of the forty patients (significantly greater than control subjects; (p less than 0.005) and correlated with widespread, active discoid lupus erythematosus, an elevated erythrocyte sedimentation rate, and a slightly greater risk of systemic lupus erythematosus in 1982. At the 2-year follow-up examination, thirteen of the seventeen patients with a positive ANA had active clinical cutaneous disease, and ten of the sixteen patients with negative ANA findings had continued activity (not statistically significant). However, all seven patients with elevated ssDNA antibody levels had continued activity, and disease progression had occurred in three.

Thus the presence of ssDNA seems to correlate strongly with active, progressive lupus erythematosus. The presence of antibody abnormalities in patients with discoid lupus erythematosus correlates with clinical disease and provides more support for the theory linking discoid lupus erythematosus to systemic lupus erythematosus as part of a continuum.


=====================================================================br> 62.) Squamous cell carcinoma of the lip developing in discoid lupus erythematosus.
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SO - Oral Surg Oral Med Oral Pathol 1985 Oct;60(4):382-6
AU - Handlers JP; Abrams AM; Aberle AM; Auyong T; Melrose RJ
PPT - JOURNAL ARTICLE

AB - Since the substitution of steroids and antimalarials for irradiation in the treatment of discoid lupus erythematosus, squamous cell carcinoma arising in discoid lupus erythematosus is thought by some to be an uncommon occurrence. A review of the recent literature (subsequent to 1945) revealed fifteen cases, of which seven occurred in the lips. In one of twelve of the cases a history of irradiation was documented. In three other cases, there was no evidence of its use.

We report an additional case of squamous cell carcinoma occurring in the lower lip of a 24-year-old black woman in the absence of radiation therapy. A review of the literature and a discussion of possible predisposing factors are presented.

======================================================================br> DATA-MÉDICOS/DERMAGIC-EXPRESS No (52) 05/05/99 DR. JOSÉ LAPENTA R. 
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