CUTANEOUS MANIFESTATIONS OF SYSTEMIC LUPUS-ERYTHEMATOSUS

We have assessed the cutaneous signs in 73 patients with systemic lupu s erythematosus (SLE), seen during a 5-year period in an English hospi tal. Most previous information about the cutaneous manifestations of S LE has been obtained from studies performed in the U.S.A. We classifie d lesions as specific cutaneous and mucosal LE (acute, subacute and ch ronic) or non-specific LE-related, e.g. photosensitivity, urticaria er ythema, Raynaud's phenomenon or vasculitis, Acute cutaneous LE lesions included a butterfly rash with erythematous macules, telangiectasia o r papulosquamous lesions, seen in 37 patients (51%) and facial oedema seen in four patients (5%), Five patients (7%) had psoriasiform subacu te cutaneous LE, Chronic cutaneous LE was common: 18 patients (25%) ha d chronic discoid lesions (DLE) and, in 12 (15%), these had preceded s ystemic disease. One patient had facial lupus profundus, Ten patients (14%) had scarring alopecia secondary to DLE. Fifteen patients (20.5%) had chronic chilblain lupus. Twenty-three patients (31.5%) had a hist ory of mouth ulceration, Of these, 11 (15%) gave a history of ulcers a t the onset of their disease. Three (4%) had erythema and superficial ulceration of the palate, not typical of aphthous ulcers, and three (4 %) had chronic buccal plaques, Cheilitis due to DLE was seen in three (4%), episcleritis in three (4%), five (7%) had nasal disease, six (8% ) bullous skin eruptions, one 'the bullous eruption of SLE', four bull ae associated with cutaneous vasculitis, and one bullae associated wit h ultraviolet radiation, Forty-six (63%) observed photosensitivity. A non-scarring alopecia occurred in 29 (40%), Vascular phenomena were co mmon: three patients (4%) had chronic palmar erythema, Raynaud's pheno menon occurred in 44 patients (60%), chronic urticaria, worsened by su n exposure, was noted by 32 (44%) (in whom the lesions often lasted mo re than 36 h), eight (11%) had cutaneous vasculitis and three (4%) liv edo reticularis. Skin changes play a prominent part in SLE and may pro vide helpful diagnostic information. In this British population, chilb lains and urticaria were particularly common. Lesions of subacute cuta neous LE were relatively unusual in this group of patients with SLE.