The patient is a 45-year-old Caucasian male with a 5-year history of systemic lupus erythematosus (SLE). He has flat erythema that is more prominent on the upper chest, neck, and head. The rash produces a constant mild generalized sunburn sensation and is more severe during flares. He has sporadic non-specific skin lesions. He has a high titer of Ro/SS-A antibodies, high titer of anticardiolipin antibodies, depressed serum complement levels, and mild proteinuria.
The pathology reports of the red facial lesion (see Figure 1) and magenta color wrist lesion (see Figure 2) demonstrate vacuolar degeneration of the basalar layer, perivascular and periadnexal inflammatory infiltrates, edema, vasodilatation, and extravasation of erythrocytes, which is suggestive of lupus. The pustular lesion (see Figure 3) is slightly atypical of lupus, but may represent an acute inflammatory component rather than a classic chronic component of lupus. The patient has no underlying bacterial, viral, or fungal infections. Figure 4 shows a distinct erythema in the neck and head. The erythema in the neck is a red to magenta color and takes on the appearance of piloerection (see Figure 5), commonly called "goose flesh" or "chicken skin."
Red raised lesions have a gradual onset. These lesions are present for several weeks and then gradually fade.
Sometimes lesions appear as a magenta color. This lesion was one of six that appeared during a flare.
Pustular-like lesions appear suddenly and then fade over several hours.
Erythema of the neck and head. Note the white demarcation "strip" between the upper portion of the neck and the jaw. The jaw is protecting the upper portion of the neck from light sources.
The rash in the neck appears more as a magenta color and piloerection is more pronounced with overexposure to light and during flares.
Many of the rashes and lesions in SLE are commonly related to sun exposure and fluorescent lighting and are frequently associated with antibodies to Ro/SS-A. The etiology of these rashes can be divided into those that are specific to lupus and those that can occur in other diseases as well as lupus.
Rashes associated with antibodies to Ro/SS-A typically occur on the head, neck, chest, and outer arms.
Specific and nonspecific rashes associated with antibodies to Ro/SS-A are often related to subacute cutaneous lupus erythematosus (SCLE). Typically, lesions specific to SCLE do not itch and may look similar to that of psoriasis. Rashes associated with SCLE may occur alone or co-exist with SLE. Other conditions commonly seen in patients with these antibodies are vasculitic-syndromes, Sjogren's syndrome, and congenital heart block in neonates born to women with SSA-Ro.
Antimalarial agents such as hydroxycholoroquine (Plaquenil®) are commonly used to treat SCLE. Steroids and cytotoxic agents may be used in severe cases and during flares.
The skin rashes associated with antibodies to Ro/SS-A in SCLE may wax and wane during the course of the illness.
Patients should be instructed to minimize exposure to the sun and fluorescent lighting. A sun protection factor (SPF) of 30 or higher is recommended. It is also important to have routine eye examinations when taking antimalarial agents.
The "Clinical Snapshot" series provides a concise examination of a clinical presentation including history, treatment, patient education, and nursing measures. Using the format here, you are invited to submit your "Clinical Snapshot" to Dermatology Nursing.
Dermatology Nursing. 2006;18(2):168, 177 © 2006 Jannetti Publications, Inc.
Cite this: Skin Rashes in a Patient With Antibodies to Ro/SS-A - Medscape - Apr 01, 2006.
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