Involvement of scalp and nails in lupus erythematosus

Abstract

Lupus erythematosus (LE) is a systemic autoimmune disorder associated with polyclonal B-cell activation resulting in diverse patterns of autoantibody production and a heterogeneous clinical expression constituting a spectrum extending from limited cutaneous disease to life-threatening systemic manifestations. For daily clinical practice, the characteristics of cutaneous lupus erythematosus (CLE) have been well defined in terms of morphology, and clinical and laboratory criteria are available for the classification as systemic lupus erythematosus (SLE). The many different types of skin lesions encountered in patients with LE have been classified into those that are histologically specific for LE and those that are not. While LE non-specific skin lesions on their own do not enable a diagnosis of LE, they can be important reflections of underlying SLE disease activity. This also applies to the involvement of the scalp and nails. Finally, it must be kept in mind that LE patients may also develop drug-related, or other unrelated common disorders of the hair and nails that do not reflect LE disease activity. Lupus (2010) 19, 1078—1086.

Keywords

alopecia cutaneous lupus erythematosus discoid lupus erythematosus effluvium hair lupus hair nails Raynaud’s phenomenon SLE splinter haemorrhage

Get full access to this article

View all access options for this article.

References

Prystowsky SD , Herndon JH , Gilliam JN Chronic cutaneous lupus erythematosus (DLE): a clinical and laboratory investigation of 80 patients . Medicine (Baltimore) 1976; 55: 183-191.

Sontheimer RD , Provost TT Lupus erythematosus. In: Sontheimer RD , Provost TT (eds), Cutaneous manifestations of rheumatic diseases . Baltimore, MD: William & Wilinis; 1996. p. 1-72.

Lehmann P. , Holzle E. , Kind P. , Goerz G. , Plewig G. Experimental reproduction of skin lesions in lupus erythematosus by UVA and UVB radiation. J Am Acad Dermatol 1990; 22: 181-187.

Rowell NR , Goodfield MJD. The connective tissue diseases. In: Champion RH , Burtion JL , Ebling FJG (eds), Lupus erythematosus , 3rd edn. Philadephia, PA: Lea & Febiger; 1987.

Wilson CL , Burge SM , Dean D. , Dawber RPR. Scarring alopecia in discoid lupus erythematosus. Br J Dermatol 1992; 126: 307-314.

Sulica VI , Kao GF Squamous-cell carcinoma of the scalp arising in lesions of discoid lupus erythematosus . Am J Dermatopathol 1988; 10: 137-141.

Crowson AN , Margo C. The cutaneous pathology of lupus erythematosus: a review. J Cutan Pathol 2001; 28: 1-23.

Abell E. Immunofluorescent staining technics in the diagnosis of alopecia. South Med J 1977; 70: 1407-1410.

Jordon RE Subtle clues to diagnosis by immunopathology. Scarring alopecia. Am J Dermatopathol 1980; 2: 157-159.

10.

Elston DM , Bergfeld WF Cicatricial alopecia (and other causes of permanent alopecia). In: Olsen EA (ed.), Disorders of hair growth . Diagnosis and treatment. McGraw Hill ; 1994. p. 285-313.

11.

Braun-Falco O. , Imei S. , Schmoeckel C. , Steger O. , Bergner T. Pseudopelade of Brocq. Dermatologica 1986; 172: 18-23.

12.

Templeton SF , Solomon AR Scarring alopecia: a classification based on microscopic criteria. J Cutan Pathol 1994 ; 21: 97-109.

13.

Sperling LC Scarring alopecia and the dermatopathologist . J Cutan Pathol 2001; 28: 333-342.

14.

Trachsler S. , Trueb RM Value of direct immunofluorescence for differential diagnosis of cicatricial alopecia. Dermatology 2005; 211: 98-102.

15.

Alarcon-Segovia D. , Cetina JA Lupus hair. Am J Med Sci 1974; 267: 241-242.

16.

Sperling LC , Lupton GP Histopathology of non-scarring alopecia. J Cutan Pathol 1995; 22: 97-114.

17.

Marriott P. , Borrie PF Pigmentary changes following chloroquine . Proc R Soc Med 1975; 68: 535-536.

18.

Litt JZ Drug eruption reference manual. New York: Parthenon Publishing Group; 2001.

19.

Bauer F. Quinacrine hydrochloride drug eruption (tropical lichenoid dermatitis). Its early and late sequelae and its malignant potential: a review. J Am Acad Dermatol 1981; 4: 239-248.

20.

Werth VP , Sanchez M. , White W. , Franks AG Alopecia areata with lupus erythematosus (abstract). Arthritis Rheum 1989; 32(Suppl): R17.

21.

Trüeb RF , Trüeb RM Kutane Paraneoplasie als immunologisches Phänomen am Beispiel des paraneoplastischen subakuten kutanen Lupus erythematodes . Schweiz Rundsch Med Prax 1999; 88: 1803-1810.

22.

Buck DC , Dodd HJ , Sarkany I. Hypertrophic lupus erythematosus. Br J Dermatol 1988; 119: 72-74.

23.

Doutre MS , Beylot C. , Beylot J. , Pompougnac E. , Royer P. Chilblain lupus erythematosus: report of 15 cases. Dermatology 1992; 184: 26-28.

24.

McCarthy L. Lupus erythematosus unguium mutilans treated with gold and sodium thiosulphate. Arch Dermatol Syph 1931; 24: 647-654.

25.

Kint A. , van Harpe L. Ungual anomalies in lupus erythematosus discoides. Dermatologica 1976; 153: 298.

26.

Urowitz MB , Gladman DD , Chalmers A. , Ogryzlo MA Nail lesions in systemic lupus erythematosus. J Rheumatol 1978; 5: 441-447.

27.

Vaughn RY , Bailey Jr JP , Field RS , et al. Diffuse nail dyschromia in black patients with systemic lupus erythematosus. J Rheumatol 1990; 17: 640-643.

28.

Wollina U. , Barta U. , Uhlemann C. , Oelzner P. Lupus erythematosus-associated red lunula. J Am Acad Dermatol 1999; 41: 419-421.

29.

García-Patos V. , Bartralot R. , Ordi J. , Baselga E. , de Moragas JM , Castells A. Systemic lupus erythematosus presenting with red lunulae. J Am Acad Dermatol 1997; 36: 834-836.

30.

Francès C. , Piette JC , Saada V. , et al. Multiple subungual splinter hemorrhages in the antiphospholipid syndrome: a report of five cases and review of the literature. Lupus 1994; 3: 123-128.

31.

Schnitzler L. , Baran R. , Verret JL La biopsie du repli sus-ungueal dans les maladies dited du callagene. Etude histologique, ultrastructurale et en immunofluorescence de 26 cas. Ann Derm Venereol 1980; 107: 777-785.

32.

Dubois EL , Tuffanelli DL Clinical manifestations of systemic lupus erythematosus. Computer analysis of 520 cases. JAMA 1964; 190: 104-111.

33.

Hochberg MC , Boyd RB , Ahearn JM , et al. Systemic lupus erythematosus: a review of clinico-laboratory features and immunogenetic markers in 150 patients with emphasis on demographic subsets. Medicine (Baltimore) 1985; 64: 285-295.

34.

Caputo R. , Cappio F. , Rigoni C. , et al. Pterygium inversum unguis. Report of 19 cases and review of the literature. Arch Dermatol 1993; 129: 1307-1309.

35.

Tosti A. The nail apparatus in collagen disorders. Semin Dermatol 1991; 10: 71-76.

36.

Ohtsuka T. Quantitative analysis of nailfold capillary abnormalities in patients with connective tissue diseases. Int J Dermatol 1999; 38: 757-764.

37.

Goldman L. A simple portable capillaroscope. Arch Dermatol 1981; 117: 605-606.

38.

Redisch W. , Messina EJ , Hughes G. , McEwen C. Capillaroscopic observations in rheumatic diseases. Ann Rheum Dis 1970; 29: 244-253.

39.

Granier F. , Vayssairat M. , Priollet P. , Housset E. Nailfold capillary microscopy in mixed connective tissue disease. Comparison with systemic sclerosis and systemic lupus erythematosus. Arthritis Rheum 1986; 29: 189-195.

40.

Trüeb RM Hair and nail involvement in lupus erythematosus . Clin Dermatol 2004; 22: 139-47.