LUPUS-ERYTHEMATOSUS PANNICULITIS WITH MORPHEA-LIKE LESIONS

A 22-year-old female with morphea-like lesions, deep subcutaneous nodu les and lipoatrophic areas of the skin on lateral aspects of the upper arms, on the breasts and on the buttocks is described. In 1990 a biop sy specimen obtained from a subcutaneous nodule showed hyaline necrosi s of fat tissue; there were no epidermal changes. Direct immunofluores cence revealed granular deposits of IgM at the dermo-epidermal junctio n of the skin overlying the subcutaneous nodule. In a biopsy specimen taken at the onset of the disease in 1988, hyaline sclerosis of the de ep dermis, follicular hyperkeratosis and vacuolar degeneration in the epidermis were described. There was weak positivity for antinuclear an tibodies. The diagnosis of lupus erythematosus panniculitis (LEP) was made. Administration of chloroquine resulted in complete clearing of n odules in 3 months. The reported case demonstrates the difficulties in establishing the diagnosis of LEP in patients who present with subcut aneous disease, morphea-like lesions and who do not have other clinica l or laboratory evidence of lupus erythematosus. The differential diag nosis of LEP and deep morphea is discussed.