eMedicine Specialties > Dermatology > Connective Tissue Diseases

Lupus Erythematosus, Acute: Differential Diagnoses & Workup

Author: Charmaine Browne, MD, FRCP(C), Clinical Assistant Professor, Department of Dermatology, University of Texas Southwestern Medical Center at Dallas; Clinical Assistant Professor, Department of Dermatology, University of Texas Health Science Center at San Antonio
Contributor Information and Disclosures

Updated: Jul 15, 2009

Differential Diagnoses

Dermatomyositis
Drug Eruptions
Drug-Induced Photosensitivity
Seborrheic Dermatitis

Other Problems to Be Considered

Acne rosacea

Workup

Laboratory Studies

  • Since acute cutaneous lupus erythematosus (ACLE) and systemic lupus erythematosus (SLE) are associated closely, it is safe to assume that the laboratory findings in systemic lupus erythematosus closely mirror the findings in acute cutaneous lupus erythematosus.
  • Antinuclear antibody (ANA) assay: ANA results invariably are positive in patients with systemic lupus erythematosus and, therefore, in patients with acute cutaneous lupus erythematosus. The peripheral rim pattern is associated most strongly with lupus erythematosus, although other patterns commonly are present. ANA results are less likely to be positive in dermatomyositis, which mimics lupus erythematosus both clinically and histologically.
  • Anti–double-stranded DNA antibody (anti-dsDNA) assay: Anti-dsDNA is specific for systemic lupus erythematosus and is present in 60-80% of patients with acute cutaneous lupus erythematosus, often in high titers.
  • Complement: Complement levels usually are depressed in patients with acute cutaneous lupus erythematosus.
  • Anti-Sm antibody assay: Anti-Sm antibody has a strong specificity for systemic lupus erythematosus; therefore, perform this assay to exclude underlying systemic involvement. This is particularly relevant in patients in whom anti-dsDNA results are negative.
  • Low-specificity tests
    • U1 ribonucleoprotein antibody assay: Results are positive in mixed connective-tissue disease, which sometimes manifests as a malar eruption.
    • CBC count: Anemia, leukopenia, and/or thrombocytopenia may be seen in patients with acute cutaneous lupus erythematosus who have systemic involvement.
    • Erythrocyte sedimentation rate: Although a nonspecific marker, marked elevations in levels indicate possible systemic involvement.
    • Urinalysis: Proteinuria, hematuria, and urine casts are indicative of underlying nephritis.
    • Creatinine and BUN levels: Elevation indicates renal compromise.

Procedures

  • Skin biopsy: Diagnosis is supported by histopathologic examination of the skin. Further substantiation is obtained by performing immunofluorescence examination of skin lesions.

Histologic Findings

The most striking change in acute cutaneous lupus erythematosus is the presence of edema involving upper dermis and focal liquefactive degeneration of the basal cell layer. Cellular dermal infiltrate is sparse and consists of lymphocytes. In extreme cases, dissolution of the basal layer occurs secondary to extensive vacuolization, forming a subepidermal bulla.4

More on Lupus Erythematosus, Acute

Overview: Lupus Erythematosus, Acute
Differential Diagnoses & Workup: Lupus Erythematosus, Acute
Treatment & Medication: Lupus Erythematosus, Acute
Follow-up: Lupus Erythematosus, Acute
Multimedia: Lupus Erythematosus, Acute
References
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References

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Further Reading

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Keywords

acute lupus erythematosus, acute cutaneous lupus erythematosus, ACLE, LE, subacute cutaneous lupus erythematosus, SCLE, chronic cutaneous lupus erythematosus, CCLE, butterfly rash, malar rash, photosensitive lupus dermatitis

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Contributor Information and Disclosures

Author

Charmaine Browne, MD, FRCP(C), Clinical Assistant Professor, Department of Dermatology, University of Texas Southwestern Medical Center at Dallas; Clinical Assistant Professor, Department of Dermatology, University of Texas Health Science Center at San Antonio
Charmaine Browne, MD, FRCP(C) is a member of the following medical societies: American Academy of Dermatology, American Medical Association, International Society of Dermatology, Royal College of Physicians and Surgeons of Canada, Society for Pediatric Dermatology, Texas Dermatological Society, and Texas Medical Association
Disclosure: Nothing to disclose.

Medical Editor

Kathleen David-Bajar, MD, Former Consultant to the Army Surgeon General, Department of Dermatology, Brooke Army Medical Center
Kathleen David-Bajar, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Dermatology
Disclosure: Nothing to disclose.

Pharmacy Editor

Richard P Vinson, MD, Assistant Clinical Professor, Department of Dermatology, Texas Tech University School of Medicine; Consulting Staff, Mountain View Dermatology, PA
Richard P Vinson, MD is a member of the following medical societies: American Academy of Dermatology, Association of Military Dermatologists, Texas Dermatological Society, and Texas Medical Association
Disclosure: Nothing to disclose.

Managing Editor

Jeffrey P Callen, MD, Professor of Medicine, Chief, Division of Dermatology, University of Louisville School of Medicine
Jeffrey P Callen, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American College of Physicians, and American College of Rheumatology
Disclosure: Amgen Honoraria Consulting; Abbott Honoraria Consulting; Electrical Optical Sciences Honoraria Consulting; Centocor Honoraria Consulting; Genetech Honoraria Consulting; Celgene Honoraria Consulting

CME Editor

Joel M Gelfand, MD, MSCE, Medical Director, Clinical Studies Unit, Assistant Professor, Department of Dermatology, Associate Scholar, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania
Joel M Gelfand, MD, MSCE is a member of the following medical societies: Society for Investigative Dermatology
Disclosure: AMGEN Consulting fee Consulting; AMGEN Grant/research funds None; Genentech Consulting fee Consulting; Centocor Consulting fee Consulting; Centocor Grant/research funds None; Covance Consulting fee Consulting; Shire  Consulting

Chief Editor

Dirk M Elston, MD, Director, Department of Dermatology, Geisinger Medical Center
Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology
Disclosure: Nothing to disclose.

 
 
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