1. SYSTEMIC LUPUS ERYTHEMATOSUS

2. DEFINATION
SYSTAMIC LUPUS ERYTHEMATOSUS IS A DISEASE OF UNKNOWN ETIOLOGY IN WHICH TISSUES AND CELLS ARE DAMAGED BY PATHOGENIC AUTOANTIBODIES AND IMMUNE COMPLEXES
90% OF CASES ARE WOMEN USUSALLY CHID-BEARING AGE BUT CHILDREN, MEN AND ELDERLY PERSON CAN BE AFECTED
PRAVELENCE RATE IS APPROX.15 TO 50 CASES PER 100,000 POPULATION

3. SPECTRUM OF DISEASE

4. ACLE – ACUTE CUTANEOUS LUPUS ERYTHEMATOSUS
SCLE – SUB ACUTE CUTANEOUS LUPUS ERYTHEMATOSUS
CCLE – CHRONIC CUTANEOUS LUPUS ERYTHEMATOSUS

5. PATHOGENESIS TISSUE DAMAGE CAUSED BY AUTOANTIBODIES IMMUNE COMPLEXES
ABNORMAL IMMUNE RESPONSES ARE
1. POLYCLONAL ANTIGEN SPECIFIC T & B CELL HYPERREACTIVITY
2. INADEQUATE REGULATION OF HYPERREACTIVITY

6. ABNORMAL IMMUNE RESPONSES DEPEND UPON INTERACTION BETWEEN
SUSCEPTIBILITY GENES ACLE - DR2,DR SCLE- HLA-B8,DR3 & DEFICIENCES OF C2,C3,C DLE - HLA B-7 DR2,DR3,DQ
ENVIRONMENT-
1. UV LIGHT >70 % CASES HAS PHOTOSENSITIVITY
2. DRUGS - PROCAINAMIDE, HYDRALAZINE, INH, PHENYTOIN, MINOCYCLINE VIRUSES CMV, EPSTEIN-BARR VIRUSES

7. PATHOGENESIS

8. CLINICAL MANIFESTATION
ACLE – SKIN LESIONS WAX & WANE IN PARALLEL WITH UNDERLYING DISEASE ACTIVITY, NO SCARRING
LOCALISED SYMETIRCAL ERYTHEMA & EDEMA AT MALAR EMINENCES
GENERALISED - MORBILLIFORM/ EXANTHEMATOUS ERUOTIONS
SCLE - PHOTOSENSITIVITY
ANNULAR ERYTHEMA, PSORIASIFORM , EM. EYRTHRODERMA.&
NO SCARRING
ASSOCOATION WITH RO/SS-A ANTIBODIES & MALIGNANCIES-BREAST,LUNGS,GI,HODGKIN’S DISEASE. AOTOIMMUNE DISEASES

9. CCLE
DISCOID ERYTHEMATOUS PLAQUES WITH ADHERENT SCALE & FOLLICULAR PLUGS-CARPET TACK SIGN
HYPERPIGMENTATION AT PERIPHERY, AROPHIC CENTRAL SCARING,
TELENGIEACTASIA,
HYPOPIGMENTATION,
SCARING ALOPECIAS,
OCCURS AT SUN EXPOSED AREAS
HYPERTROPHIC DLE
BULLOUS LESIONS
MUCOSAL – 25% OF CASES
LUPUS PANNICULITIS

10. AUTOANTIBODIES ASSOCATION
ANTIGEN
MOLECULAR SPECIFICITY
CLINICAL ASSOCIATION
HIGH DISEASE SPECIFICITY FOR SLE
ANA %
dsDNA %
Sm %
rRNp % -
Native DNA
Ribonucleoprotein
Ribosomal P protein
SLE,
LE Nephritis
CNS LE
LOW DISEASE SPECIFICITY FOR SLE
ssDNA %
Histones %
Ro/SS-A %
La/Ss-B %
Denatured DNA
Histones
Ribonucleoproteins
Risk for SLE in DLE
Drug induced SLE
SCLE, neonatal LE, SSj
SSJ, SCLE

11. RISK FACTORS FOR DEVELOPMENT OF SLE IN PAITENT OF DLE
DIFFUSE NONSARRING ALOPECIA
GENERELISED LYMPHADENOPATHY
PERIUNGAL NAIL FOLD TELENGIACTASIA
RAYNAUD’S PHENOMENON
UNEXPLANED ANEMIA
LEUCOPENIA
FALSE POSITIVE TEST FOR SYPHILS
HIGH TITER OF ANA
ANTI ssDNA ANTIBODIES
ELEVETED ESR

12. ACUTE LE
BUTTER FLY
LESION

13. ERYTHEMA AT DORSA OF HAND

14. SKIN LESION OF SCLE

15. SCLE

16. DLE

17. DLE

18. DLE LESION AT PINNA

19. DLE LESION

28. CICATRICAL ALOPECIA

30. ORAL LESION

32. HISTOPATHOLOGY

33. IMMUNOHISTOLOGY

34. TREATMENT LOCAL – SYSTAMIC SUN SCREENS TOPICAL GLUCOCORTICOCOIDS
ANTIMALARIALS-
CHLOROQUIN
HYDROXYCHOLROQUIN
DAPSONE
RETINOIDS
CLOFAZIMINE
SYSTAMIC GLUCOCORTICOIDS
AZATHIOPRINE
CYCLOPHOSPHAMIDE