LUPUS ERYTHEMATOSUS LE ETIOLOGY 1 Infectious origin

LUPUS ERYTHEMATOSUS (LE)

ETIOLOGY 1. Infectious origin 2. Viral genesis 3. Hereditary predisposition 4. Neurogenic theory 5. Photosensibilization

Pathogenesis Provoke factors (hereditary predisposition, sunlight, chronic infections, concomitant diseases, drugs, stress)

Decrease of T-suppressor and T-killers, increase of T-helpers Antinuclear factor (LE-factor) Nucleophagocytosis – LE phenomenon LE-cells

Deposition of immune complexes in the organism Activation of complement system Generate the assembly of the membraneattack complex Membrane injury

Classification of LE Cutaneous LE Systemic LE а) disseminated а) Acute б) erythema centrifugum (Biett`s disease) в) lupus erythematosus profundus (the Kaposi-Irgang disease б) Subacute в) Chronic

Classification (by American College of Rheumatology) I. Systemic LE II. Cutaneous LE Subacute LE Chronic LE Discoid LE LE profundus

Physical examination Discoid LE

Disseminated form

Hypertrophic/ verrucous form

Erythema centrifugum (Biett`s disease)

Lupus profundus (Kaposi- Irgang disease)

Systemic LE

Differential diagnosis 1. Psoriasis 2. Seborrheic dermatitis 3. Tinea corporis (Trichophytia) 4. Erythema multiform 5. LP Systemic LE 1. Erysipelas 2. Diffuse systemic scleroderma 3. Dermatomyositis

Diagnosis • 1. Butterfly rash • 2. Discoid plaques • 3. Photosensibilization • 4. Oral ulcers • 5. Arthritis • 6. Serositis (pleuritis, pericarditis)

• 7. Renal disorder 8. Neurologic disorder 9. Hematologic disorder 10. Immunologic disorder 11. Antinuclear antibody

Diagnosis 1. Clinical findings 2. Laboratory methods: а) Serology б) Laboratory methods: Immunofluorescence- direct (biopsy sample is used) Immunofluorescence- indirect (serum is used); в) Reveal of LE-cells 3. Dermatopathology

Management

Management (discoid form) 1. Topical sunscreens (SPF 30) 2. Angioprotectors 3. Vitamins (А, В 2, В 6, В 12, С); 4. Retinoid (Etretinate). 5. Immune drugs 6. Riboxin Topical: Topical fluorinated glucocorticoids (ointment and creams) Injections of 10% Chloroquin solution Cryodestruction

Management (systemic form) • Glucocorticoids • Immunosuppressive drugs • Antimalarials • Immunomodulators • Hepatoprotectors • Vitamins • enterosorbents • Symptomatic therapy