Acute Cutaneous Lupus Erythematosus (ACLE) Workup
- Author: Ivan D Camacho, MD; Chief Editor: William D James, MD more...
Because acute cutaneous lupus erythematosus and systemic lupus erythematosus 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.
Diagnostic data from laboratory tests are supported by histopathologic examination of the skin. Further diagnostic substantiation is obtained by performing immunofluorescent examination of skin lesions.
The most striking histologic 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.
As previously mentioned, ANA assay 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 deoxyribonucleic acid (DNA) antibody (anti-dsDNA) assay is specific for systemic lupus erythematosus and is present in 60-80% of patients with acute cutaneous lupus erythematosus, often in high titers.
Complement levels usually are depressed in patients with acute cutaneous lupus erythematosus.
Anti-Sm antibody assay 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.
Ro (SS-A) antibodies are often correlated with cutaneous involvement in subacute cutaneous lupus erythematosus. However, almost a third of Ro antibody – positive patients with acute cutaneous lupus erythematosus present with kidney involvement, particularly young female patients.
A positive rheumatoid factor and speckled ANA pattern may be seen in association with Rowell syndrome.
Low-specificity tests include the following:
U1 ribonucleoprotein antibody assay - Results are positive in mixed connective-tissue disease, which sometimes manifests as a malar eruption
Complete blood count (CBC) - 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 blood urea nitrogen (BUN) levels - Elevation indicates renal compromise
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