Persistant Urticarial Plaques of Lupus Erythematosus Tumidus: A Case Report

Case Report

Austin J Dermatolog. 2014;1(5): 1023.

Persistant Urticarial Plaques of Lupus Erythematosus Tumidus: A Case Report

Uzuncakmak TK1*, Karadag AS1, Akdeniz N1, Zindanci I1, Zemheri E2 and Ozkanli S2

1Department of Dermatology, Istanbul Medeniyet University, Turkey

2Department of Pathology, Istanbul Medeniyet University, Turkey

*Corresponding author: Tugba Kevser Uzuncakmak, Department of Dermatology, Istanbul Medeniyet University, Goztepe Research and Training Hospital, Istanbul, Turkey

Received: August 21, 2014; Accepted: September 30, 2014; Published: October 02, 2014

Abstract

Lupus erythematosus tumidus is an uncommon variant of chronic cutaneous lupus erythematosus and characterized by erythematous, pruritic urticarial papules and plaques without any epidermal changes. Lesions are usually localized on sun-exposed areas like face or trunk and commonly resolve without scarring.

We want to present a 43 year-old female patient with pruritic, erythematous and edematous papules and plaques on her back for 8 years. Her lesions first appeared in spring and summer time in first 3 years then remained stable for all seasons. Histopathological examination of these lesions were consistent with lupus erythematosus tumidus and responsed very-well to systemic hydroxychloroquine therapy in one month. We want to remind lupus erythematosus tumidus in differential diagnosis of pruritic, urticarial papules and plaques which are localized on places that do not expose to sun.

Keywords: Cutaneous lupus erythematosus; Lupus erythematosus tumidus; Pruritus

Introduction

Lupus Erythematosus Tumidus (LET) is the most photosensitive variant of cutaneous Lupus Erythematosus (LE) and in clinical practice it is one of the rare variants of LE. Clinical manifestation of LET is characterized by smooth, erythematous urticarial plaques on sun-exposed areas without any epidermal changes, such as erosion, follicular plugs, atrophy or scale against to other forms of lupus erythematosus. Central healing is another feature of LET. Jessner’s lymphocytic infiltration, polymorphous light eruption, Reticular Erythematous Mucinosis (REM), urticarial vasculitis and pseudolymphoma are most important diseases in differential diagnosis [1-3]. Recently LET is offered to be classified as a separate entity more than a subytpe of chronic cutaneous lupus erythematosus as well the presence of lupus tumidus lesions in patients with other types of LE leads to classification as a subtype of LE [4].

Herein we present a female patient with urticarial papules and plaques on her back which was consistent with lupus erythematosus tumidus clinically and histopathologically.

Case Report

A 48-year-old female patient presented to our outpatient clinic with persistant pruritic erythematous papules and plaques on her back for 8 years (Figure 1). Her lesions appeared in spring and summer time in first three years but then these lesions have persisted for all seasons. She does not have any systemic symptom or a drug history. A punch biopsy and a direct immunfloresence specimen were taken from her back with initial diagnoses of subacute cutaneous lupus erythematosus, sarcoidosis, Grover’s disease, erythema annulare centrifigum, granuloma anulare and polymorphous light eruption from her back.