Systemic Lupus Erythematosus

March 29, 2012 by staff 

Systemic Lupus Erythematosus, Nondermatologists often have a dickens of a time differentiating the malar rash that’s a hallmark of systemic lupus erythematosus from butterfly midfacial rashes due to other diseases, most notably rosacea and dermatomyositis. Dr. Ruth Ann Vleugels has provided some useful tips.

The malar rash of systemic lupus erythematosus (SLE) consistently spares the nasolabial folds, for reasons unknown. So, if a red, butterfly-shaped rash on the central face involves the nasolabial area, it’s not SLE, she explained at the symposium.

In contrast, when the erythrotelangiectatic or papulopustular variants of rosacea blanket the midface with a rash that looks much like the malar rash of SLE, the nasolabial area is included, not spared.

“Rosacea with a rash on the malar area and photosensitivity are very common in young, fair-skinned women, as is lupus. These patients with rosacea often get [antinuclear antibody (ANA)] testing. A lot of them will be positive, so already they have three ACR criteria for SLE, and they end up in your office,” said Dr. Vleugels, a dermatologist who is director of the connective tissue disease clinic at Brigham and Women’s Hospital and codirector of the rheumatology-dermatology clinic at Children’s Hospital, Boston.

Alopecia and hemorrhagic crusting on the lips are common in patients with SLE, not so in rosacea. Also, patients who present with rosacea are usually in general good health, whereas those with the malar rash of SLE often feel sick and have systemic findings at presentation.

It’s helpful to ask whether the patient has noticed if the rash has other triggers in addition to sunlight. Alcohol and spicy foods are two of the most common ones in rosacea.

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