Case and Research Letters
Coexistence of Tumid Lupus Erythematosus and Discoid Lupus Erythematosus
Coexistencia de lupus eritematoso túmido y lupus eritematoso discoide
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B) Placa eritemato-marronácea, descamativa, alopécica a nivel del cuero cabelludo retroauricular.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "I. Abadías-Granado, J. Sánchez-Bernal, F. Felipo-Berlanga, M. Ara-Martín" "autores" => array:4 [ 0 => array:2 [ "nombre" => "I." "apellidos" => "Abadías-Granado" ] 1 => array:2 [ "nombre" => "J." "apellidos" => "Sánchez-Bernal" ] 2 => array:2 [ "nombre" => "F." "apellidos" => "Felipo-Berlanga" ] 3 => array:2 [ "nombre" => "M." 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Abadías-Granado, J. Sánchez-Bernal, F. Felipo-Berlanga, M. Ara-Martín" "autores" => array:4 [ 0 => array:4 [ "nombre" => "I." "apellidos" => "Abadías-Granado" "email" => array:1 [ 0 => "isabel.abadiasg@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "J." "apellidos" => "Sánchez-Bernal" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "F." "apellidos" => "Felipo-Berlanga" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 3 => array:3 [ "nombre" => "M." "apellidos" => "Ara-Martín" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Dermatología, Hospital Clínico Universitario Lozano Blesa, Zaragoza, España" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Anatomía Patológica, Hospital Clínico Universitario Lozano Blesa, Zaragoza, España" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Coexistencia de lupus eritematoso túmido y lupus eritematoso discoide" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 530 "Ancho" => 750 "Tamanyo" => 142514 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Scalp biopsy showing perivascular and periadnexal lymphocytic dermatitis with epidermal atrophy, parakeratosis, and the presence of horny plugs in the follicular ostia (hematoxylin-eosin, original magnification<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>20).</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">In 1909 the term lupus erythematosus tumidus was coined by Hoffmann,<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> and in 1930 Gougerot and Burnier<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a> described the cases of 5 patients with similar clinical pictures consisting of nonscarring, erythematous, indurated facial lesions without surface changes. This condition, also known as tumid lupus erythematosus (TLE), has been largely overlooked in the literature, but has been recently characterized as a subtype of cutaneous lupus erythematosus (CLE) with peculiar clinical, photobiological, histological, and prognostic features.</p><p id="par0010" class="elsevierStylePara elsevierViewall">A 70-year-old woman with a history of hypertension and Hashimoto thyroiditis was seen for asymptomatic skin lesions on the face that had appeared during the summer 5 months earlier and were not associated with any systemic clinical signs. The appearance of the facial lesions coincided with worsening of pre-existing lesions on the scalp and associated hair loss.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Physical examination revealed the presence of erythematous, edematous, infiltrated, nondesquamative plaques on the face, cervical region, and upper chest (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>A), as well as erythematous, desquamative, alopecic plaques on the parietal and right retroauricular areas of the scalp (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>B).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">Results of previous laboratory tests performed in another center revealed that the patient was positive for antinuclear antibodies (ANA) (1:320) and negative for anti-Ro and anti-La antibodies. All other parameters were within the normal range. The results of a biopsy were consistent with lymphocytoma cutis. Given the suspicion of a lymphoproliferative process induced in response to CLE, new biopsies and laboratory tests were performed. The results revealed a decrease in ANA levels to 1:80. The pathological report of the facial lesion described discrete epidermal atrophy and a perivascular and periadnexal lymphocytic infiltrate, with no signs of interface dermatitis and abundant mucin deposition in the dermis (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). The results of the scalp biopsy were compatible with discoid lupus erythematosus (DLE) (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>).</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">Based on these results the patient was diagnosed with CLE with concomitant DLE and TLE. The patient began treatment with photoprotection, 0.05% clobetasol propionate, and hydroxychloroquine at an initial dose of 400 mg/24 h followed by subsequent maintenance therapy at 200 mg/24 h, resulting in progressive clinical improvement.</p><p id="par0030" class="elsevierStylePara elsevierViewall">The mean age of TLE patients is 36.4 to 38.5 years, and women and men appear to be affected equally.<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">3,4</span></a> Clinically, TLE is characterized by the appearance in sun-exposed areas of erythematous, succulent, urticariform, nondesquamative plaques that heal without scarring or hypopigmentation. Other characteristic features are a higher frequency of photosensitivity, as determined by phototesting, and a lower percentage positivity for anti-double-stranded DNA (dsDNA), anti-Ro (Sjögren's-syndrome-related antigen A), and anti-La (Sjögren's-syndrome-related antigen B) antibodies than described for other CLE subtypes.<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">3,4</span></a> Associated systemic disease in these patients appears to be very rare, albeit possible.<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">4,5</span></a> Histology reveals perivascular and periadnexal lymphocytic infiltrate and abundant deposition of interstitial mucin in the dermis. Compared with other CLE subtypes, the epidermis shows only mild alterations (or is intact), and basal vacuolization, hyperkeratosis, epidermal atrophy, and follicular plugging are less marked.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">6</span></a> Treatment with systemic antimalarials is effective in approximately 90% of patients, as compared with 50% of DLE patients.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a> In addition to other CLE subtypes, the differential diagnosis should include polymorphic light eruption, Jessner lymphocytic infiltrate, reticular erythematous mucinosis, and pseudolymphoma,<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a> all of which have clinical and microscopic characteristics that resemble those of TLE. Consensus is lacking regarding several aspects of TLE, including its differential diagnosis, classification, and microscopic characteristics. Because several of its features are distinct from those of other forms of lupus, some authors question the origin of TLE, and consider it a photodermatosis outside the CLE spectrum.<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">7,8</span></a> However, we believe that classification of TLE as a true lupus subtype is justified based on the evidence published to date, in particular the coexistence of TLE and DLE lesions in certain patients,<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">3–5,9,10</span></a> as in the present case. Our description of a case of coexisting TLE and DLE adds to the small number of such cases reported in the literature, and should help resolve some of the controversy surrounding TLE, facilitating earlier diagnosis of this entity and better management of affected patients.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of Interest</span><p id="par0035" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Conflicts of Interest" ] 1 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Abadías-Granado I, Sánchez-Bernal J, Felipo-Berlanga F, Ara-Martín M. Coexistencia de lupus eritematoso túmido y lupus eritematoso discoide. Actas Dermosifiliogr. 2019;110:253–255.</p>" ] ] "multimedia" => array:3 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1478 "Ancho" => 2177 "Tamanyo" => 449812 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A, Succulent, erythematous-violaceous facial plaques, without surface changes. B, Brownish, desquamative, alopecic erythematous plaque located in the retroauricular area of the scalp.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1476 "Ancho" => 2086 "Tamanyo" => 678471 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Facial skin biopsy showing discrete epidermal atrophy with moderate perivascular and periadnexal lymphocytic infiltrate and abundant deposition of mucin in the dermis. A, Hematoxylin-eosin, original magnification<span class="elsevierStyleHsp" style=""></span>×10. B, Alcian blue, original magnification×<span class="elsevierStyleHsp" style=""></span>4.</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 530 "Ancho" => 750 "Tamanyo" => 142514 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Scalp biopsy showing perivascular and periadnexal lymphocytic dermatitis with epidermal atrophy, parakeratosis, and the presence of horny plugs in the follicular ostia (hematoxylin-eosin, original magnification<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>20).</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0055" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Demonstrationen: Lupus erythematodes tumidus" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "E. Hoffmann" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Derm Zeitschr" "fecha" => "1909" "volumen" => "16" "paginaInicial" => "159" "paginaFinal" => "160" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0060" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Lupus érythémateux ‘tumidus’" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "H. Gougerot" 1 => "R. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 11 | 13 | 24 |
| 2024 October | 104 | 56 | 160 |
| 2024 September | 101 | 31 | 132 |
| 2024 August | 127 | 59 | 186 |
| 2024 July | 141 | 50 | 191 |
| 2024 June | 138 | 64 | 202 |
| 2024 May | 114 | 42 | 156 |
| 2024 April | 99 | 36 | 135 |
| 2024 March | 122 | 54 | 176 |
| 2024 February | 109 | 36 | 145 |
| 2024 January | 81 | 39 | 120 |
| 2023 December | 126 | 27 | 153 |
| 2023 November | 193 | 26 | 219 |
| 2023 October | 169 | 44 | 213 |
| 2023 September | 124 | 44 | 168 |
| 2023 August | 95 | 26 | 121 |
| 2023 July | 137 | 63 | 200 |
| 2023 June | 102 | 34 | 136 |
| 2023 May | 186 | 38 | 224 |
| 2023 April | 155 | 25 | 180 |
| 2023 March | 169 | 43 | 212 |
| 2023 February | 169 | 32 | 201 |
| 2023 January | 169 | 38 | 207 |
| 2022 December | 140 | 55 | 195 |
| 2022 November | 98 | 30 | 128 |
| 2022 October | 108 | 25 | 133 |
| 2022 September | 91 | 44 | 135 |
| 2022 August | 91 | 44 | 135 |
| 2022 July | 73 | 46 | 119 |
| 2022 June | 44 | 44 | 88 |
| 2022 May | 144 | 44 | 188 |
| 2022 April | 193 | 40 | 233 |
| 2022 March | 216 | 69 | 285 |
| 2022 February | 233 | 51 | 284 |
| 2022 January | 233 | 64 | 297 |
| 2021 December | 153 | 55 | 208 |
| 2021 November | 205 | 66 | 271 |
| 2021 October | 187 | 70 | 257 |
| 2021 September | 146 | 45 | 191 |
| 2021 August | 150 | 81 | 231 |
| 2021 July | 124 | 60 | 184 |
| 2021 June | 153 | 38 | 191 |
| 2021 May | 139 | 45 | 184 |
| 2021 April | 432 | 112 | 544 |
| 2021 March | 189 | 25 | 214 |
| 2021 February | 140 | 21 | 161 |
| 2021 January | 86 | 23 | 109 |
| 2020 December | 67 | 13 | 80 |
| 2020 November | 58 | 15 | 73 |
| 2020 October | 60 | 17 | 77 |
| 2020 September | 47 | 10 | 57 |
| 2020 August | 33 | 17 | 50 |
| 2020 July | 26 | 13 | 39 |
| 2020 June | 27 | 20 | 47 |
| 2020 May | 28 | 11 | 39 |
| 2020 April | 21 | 8 | 29 |
| 2020 March | 19 | 7 | 26 |
| 2020 February | 4 | 0 | 4 |
| 2019 May | 1 | 0 | 1 |
| 2019 April | 1 | 0 | 1 |
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