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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| año/Mes | Html | Total | |
|---|---|---|---|
| 2024 Noviembre | 13 | 13 | 26 |
| 2024 Octubre | 104 | 56 | 160 |
| 2024 Septiembre | 101 | 31 | 132 |
| 2024 Agosto | 127 | 59 | 186 |
| 2024 Julio | 141 | 50 | 191 |
| 2024 Junio | 138 | 64 | 202 |
| 2024 Mayo | 114 | 42 | 156 |
| 2024 Abril | 99 | 36 | 135 |
| 2024 Marzo | 122 | 54 | 176 |
| 2024 Febrero | 109 | 36 | 145 |
| 2024 Enero | 81 | 39 | 120 |
| 2023 Diciembre | 126 | 27 | 153 |
| 2023 Noviembre | 193 | 26 | 219 |
| 2023 Octubre | 169 | 44 | 213 |
| 2023 Septiembre | 124 | 44 | 168 |
| 2023 Agosto | 95 | 26 | 121 |
| 2023 Julio | 137 | 63 | 200 |
| 2023 Junio | 102 | 34 | 136 |
| 2023 Mayo | 186 | 38 | 224 |
| 2023 Abril | 155 | 25 | 180 |
| 2023 Marzo | 169 | 43 | 212 |
| 2023 Febrero | 169 | 32 | 201 |
| 2023 Enero | 169 | 38 | 207 |
| 2022 Diciembre | 140 | 55 | 195 |
| 2022 Noviembre | 98 | 30 | 128 |
| 2022 Octubre | 108 | 25 | 133 |
| 2022 Septiembre | 91 | 44 | 135 |
| 2022 Agosto | 91 | 44 | 135 |
| 2022 Julio | 73 | 46 | 119 |
| 2022 Junio | 44 | 44 | 88 |
| 2022 Mayo | 144 | 44 | 188 |
| 2022 Abril | 193 | 40 | 233 |
| 2022 Marzo | 216 | 69 | 285 |
| 2022 Febrero | 233 | 51 | 284 |
| 2022 Enero | 233 | 64 | 297 |
| 2021 Diciembre | 153 | 55 | 208 |
| 2021 Noviembre | 205 | 66 | 271 |
| 2021 Octubre | 187 | 70 | 257 |
| 2021 Septiembre | 146 | 45 | 191 |
| 2021 Agosto | 150 | 81 | 231 |
| 2021 Julio | 124 | 60 | 184 |
| 2021 Junio | 153 | 38 | 191 |
| 2021 Mayo | 139 | 45 | 184 |
| 2021 Abril | 432 | 112 | 544 |
| 2021 Marzo | 189 | 25 | 214 |
| 2021 Febrero | 140 | 21 | 161 |
| 2021 Enero | 86 | 23 | 109 |
| 2020 Diciembre | 67 | 13 | 80 |
| 2020 Noviembre | 58 | 15 | 73 |
| 2020 Octubre | 60 | 17 | 77 |
| 2020 Septiembre | 47 | 10 | 57 |
| 2020 Agosto | 33 | 17 | 50 |
| 2020 Julio | 26 | 13 | 39 |
| 2020 Junio | 27 | 20 | 47 |
| 2020 Mayo | 28 | 11 | 39 |
| 2020 Abril | 21 | 8 | 29 |
| 2020 Marzo | 19 | 7 | 26 |
| 2020 Febrero | 4 | 0 | 4 |
| 2019 Mayo | 1 | 0 | 1 |
| 2019 Abril | 1 | 0 | 1 |
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