Systemic Lupus Erythematosus: Considerations in Diagnosis and Management for the Inpatient Dermatologist
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HOSPITAL-BASED DERMATOLOGY (L GUGGINA AND C NGUYEN, SECTION EDITORS)
Systemic Lupus Erythematosus: Considerations in Diagnosis and Management for the Inpatient Dermatologist Nikifor K. Konstantinov 1,2 & David R. Pearson 1 Accepted: 4 September 2020 # Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose of Review Hospitalization of systemic lupus erythematosus (SLE) patients is frequent and most often due to disease flares and infection. Herein, we describe the clinical features and therapy for specific and nonspecific cutaneous manifestations of hospitalized lupus patients. Recent Findings New insights of the pathogenic mechanisms of SLE allow consideration of novel therapeutic targets and strategies. The precise role of these treatments for hospitalized SLE patients requires further study. Summary Severe lupus-specific cutaneous eruptions important for the inpatient dermatologist include acute cutaneous lupus erythematosus (ACLE), toxic-epidermal necrosis (TEN)-like ACLE, Rowell syndrome (RS), and bullous systemic lupus erythematosus (BSLE). Neonatal lupus erythematosus (NLE) and several chronic cutaneous lupus eruptions are also important considerations. Vascular manifestations and angioedema are non-specific cutaneous presentations that may cause significant morbidity and mortality. Careful assessment by a dermatologist will assist in the diagnosis and management of hospitalized patients with SLE. Keywords Cutaneous manifestations of systemic lupus erythematosus . Inpatient dermatology . Cutaneous lupus specific manifestations . Non-specific cutaneous lupus manifestations . Systemic lupus erythematosus therapy
Introduction Systemic lupus erythematosus (SLE) is a multisystem autoimmune disease diagnosed in individuals of all ages. It is characterized by the presence of autoantibodies, which are an invaluable tool to define, classify, and predict symptom onset associated with this highly heterogeneous condition [1••]. The complexity and diversity of SLE present challenges in treatment, development of new drugs, and prevention of complications [2••]. Approximately two-thirds of patients with lupus will develop cutaneous disease [3]. The skin findings in SLE are This article is part of the Topical Collection on Hospital-based Dermatology * David R. Pearson [email protected] 1
Department of Dermatology, University of Minnesota, 516 Delaware St SE, Minneapolis, MN 55455, USA
2
Department of Internal Medicine, University of Minnesota, Minneapolis, MN, USA
diverse, and based on histopathology can be divided into lupus-specific (histopathology classically demonstrates interface dermatitis) and lupus-non-specific lesions [4, 5]. A modified version of cutaneous lupus erythematosus (CLE) subtypes is presented in Table 1 [4–6, 7•], designed to emphasize the acute nature of bullous forms of lupus. A significant proportion of SLE patients are hospitalized during their disease course, with SLE flare as a leading cause of admission in 11–80.8% [8]. This broad range may reflect different clin
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