Mucocutaneous Manifestations of SLE
Skin involvement occurs in approximately 80% of Systemic Lupus Erythematosus (SLE) patients. Findings are broadly classified into Lupus-Specific (histopathologically characteristic) and Lupus-Nonspecific lesions.
I. Lupus-Specific Lesions (Gilliam Classification)
| Category | Key Clinical Features |
|---|---|
| Acute (ACLE) | Malar “butterfly” rash (spares nasolabial folds); widespread maculopapular rash (sun-exposed). |
| Subacute (SCLE) | Annular (ring-shaped) or papulosquamous (psoriasiform) patches; usually non-scarring; trunk/arms. |
| Chronic (CCLE) | Discoid Lupus (DLE): Indurated, scaly plaques, follicular plugging, scarring alopecia; prone to atrophy/scarring. |
II. Lupus-Nonspecific & Other Findings
- Mucosal: Oral or nasopharyngeal ulcers (typically painless, hard palate).
- Vascular: Raynaud’s phenomenon, livedo reticularis, cutaneous vasculitis (palpable purpura/urticarial vasculitis).
- Hair/Nails: Non-scarring diffuse alopecia (“lupus hair”), periungual telangiectasias.
- General: Photosensitivity (rash worsening after UV exposure).
High-Yield Exam Pearl:
- Malar Rash: Classic SLE sign, but only present in ~30-50% of patients; definitively spares the nasolabial folds.
- Discoid Lupus (DLE): While most DLE is cutaneous only, 5-10% of patients with chronic discoid lesions may develop systemic disease.
- Biopsy: Diagnosis of specific lesions is confirmed via punch biopsy for histology and direct immunofluorescence (Lupus Band Test).