RESUMO
OBJECTIVE: The objective of this study was to assess the risk and prevalence of oral cancer in patients with systemic lupus erythematosus (SLE) or discoid lupus erythematosus (DLE). STUDY DESIGN: The review included observational cohort and cross-sectional studies that investigated the incidence or prevalence of oral cancer in adults with confirmed diagnoses of SLE or DLE. Studies were selected based on predefined eligibility criteria, including the use of specific diagnostic criteria for SLE and DLE. After searches in PubMed/MEDLINE, EMBASE, Scopus, Web of Science, LILACS, and LIVIVO databases and gray literature for relevant studies, the selection process was conducted by independent reviewers. RESULTS: A total of 5,545 articles were identified. After screening, 8 studies met the inclusion criteria. The pooled risk estimate indicated a significantly increased risk of oral cancer in patients with SLE (risk ratio = 2.69; 95% confidence interval, 1.75 to 4.16; I2 = 0%; P = .78) compared with the general population. The pooled prevalence of oral cancer in patients with DLE was 10% (95% ci, 0.03 to 0.13; I2 = 59%; P = .12). CONCLUSIONS: This review provides evidence supporting an elevated risk for individuals with SLE or DLE developing oral cancer. The findings highlight the importance of monitoring oral mucosa in patients with these conditions.
Assuntos
Lúpus Eritematoso Discoide , Lúpus Eritematoso Sistêmico , Neoplasias Bucais , Adulto , Humanos , Estudos Transversais , Prevalência , Lúpus Eritematoso Sistêmico/complicações , Lúpus Eritematoso Sistêmico/epidemiologia , Lúpus Eritematoso Sistêmico/diagnóstico , Lúpus Eritematoso Discoide/complicações , Lúpus Eritematoso Discoide/epidemiologia , Neoplasias Bucais/epidemiologiaRESUMO
African hair shaft and pigmented scalp have unique features that challenge diagnosis in scarring alopecia. In addition, Black patients may associate 2 or more types of hair disorders. Therefore, it is imperative to understand their findings thoroughly to establish a good diagnosis. Differential diagnosis on the frontal scalp includes traction alopecia and frontal fibrosing alopecia. Disorders such as central centrifugal cicatricial alopecia, fibrosing alopecia in a pattern distribution, discoid lupus erythematosus, and lichen planopilaris usually affect the middle scalp. Folliculitis decalvans, dissecting cellulitis, and acne keloidalis nuchae are the main differential diagnosis of the posterior scalp.
Assuntos
Cicatriz , Lúpus Eritematoso Discoide , Humanos , Cicatriz/etiologia , Alopecia/diagnóstico , Alopecia/etiologia , Cabelo , Couro Cabeludo , Lúpus Eritematoso Discoide/complicações , Lúpus Eritematoso Discoide/diagnóstico , Lúpus Eritematoso Discoide/patologiaAssuntos
Lúpus Eritematoso Discoide , Couro Cabeludo , Humanos , Couro Cabeludo/patologia , Cicatriz/etiologia , Cicatriz/patologia , Alopecia/tratamento farmacológico , Alopecia/etiologia , Alopecia/patologia , Lúpus Eritematoso Discoide/complicações , Lúpus Eritematoso Discoide/tratamento farmacológicoRESUMO
BACKGROUND: Jaccoud's arthropathy (JA) is a condition characterized by joint deformities that have a "reducible" pattern, that is, they return to the normal appearance with a passive manoeuvre. JA was described in patients with rheumatic fever (RF) more than a century ago, and presently, the majority of the patients have systemic lupus erythematosus (SLE). PURPOSE: The aim of this review is to draw one attention to the epidemiology, pathogenesis, histopathology, clinical features, imaging, and management of JA in patients with SLE (Jaccoud-type lupus arthropathy). DATA COLLECTION: The search strategy included articles retrieved from PubMed utilizing the terms "lupus arthropathy", "lupus deforming arthropathy", "lupus hand", "lupus foot", "chronic postrheumatic arthropathy", "Jaccoud's" and "Jaccoud" from 1950 until March 2021, with no language restriction. RESULTS: The prevalence of Jaccoud-type arthropathy in SLE is approximately 5%. The aetiopathogenic mechanisms of JA are not yet known. The most common joint deformities of JA, are ulnar deviation, swan neck, and the "z" of the thumb. Unfortunately, none of the proposed classification criteria for JA have been validated so far. Characteristically, there is no bone erosion on plain radiographs of the joints, but more sensitive imaging methods, magnetic resonance imaging or high-performance ultrasound may reveal small bone erosions. There is no preventive measure against JA development, specific clinical treatment or convincing surgical approach for correcting the deformities. CONCLUSION: As daily activities and quality of life are compromised in patients with JA, other studies are urgently needed in this area.
Assuntos
Artrite Reumatoide , Lúpus Eritematoso Discoide , Lúpus Eritematoso Sistêmico , Humanos , Lúpus Eritematoso Discoide/complicações , Lúpus Eritematoso Sistêmico/complicações , Qualidade de Vida , RadiografiaRESUMO
OBJECTIVE: The aim of the study was to report about a patient with discoid lupus erythematosus (DLE) who developed antiphospholipid syndrome (APS) 12 years after DLE diagnosis and review related literature. PATIENTS AND METHODS: This is a case report of a 34-year-old woman with DLE who developed APS. A review of articles published in the PubMed/MEDLINE, LILACS, and SciELO databases from 1966 to October 2020 was conducted using the following search terms: "antiphospholipid syndrome," "antiphospholipid antibodies," and "discoid lupus erythematosus" No language limitation was applied. RESULTS: Besides the present case, 5 case reports were identified. One case-control and two cross-sectional studies on antiphospholipid antibodies with or without APS in DLE were also reviewed. These studies revealed that APS can develop even 37 years after DLE was diagnosed. The case-control study found that patients with DLE have more anticardiolipin antibodies than controls. In contrast, one cross-sectional study showed a low prevalence of antiphospholipid antibodies in their group of patients, which was similar to findings in the general population. CONCLUSIONS: This study reviewed previous articles on DLE cases associated with antiphospholipid antibodies and/or APS, adding a new case description.
Assuntos
Síndrome Antifosfolipídica , Lúpus Eritematoso Discoide , Lúpus Eritematoso Sistêmico , Adulto , Anticorpos Antifosfolipídeos , Síndrome Antifosfolipídica/complicações , Síndrome Antifosfolipídica/diagnóstico , Estudos de Casos e Controles , Estudos Transversais , Feminino , Humanos , Lúpus Eritematoso Discoide/complicações , Lúpus Eritematoso Discoide/diagnóstico , Lúpus Eritematoso Sistêmico/complicaçõesRESUMO
Lupus erythemathosus is a chronic, relapsing disease with acute, subacute, and chronic lesions. Effluvium telogen occurs in the setting of systemic activity of the disease, and cicatricial alopecia results from discoid lesionsin on the scalp. Other types of alopecia, like alopecia areata, may rarely be found in lupus. Frontal fibrosing alopecia is characterized by frontotemporal hairline recession and eybrow loss. Histophatologically, it cannot be differentiated from lichen planopilaris.It is controversial whether frontal fibrosing alopecia is a subtype of lichen planopilaris.. A pacient with chronic lichenoid lupus erythematosus is described with clinical, histophatological and dermoscopic features of frontal fibrosing alopecia.We have not been able to find in the literature cases of frontal fibrosing alopecia as a clinical manifestation of lupus.
Assuntos
Alopecia/complicações , Alopecia/patologia , Lúpus Eritematoso Discoide/complicações , Lúpus Eritematoso Discoide/patologia , Biópsia , Dermoscopia , Feminino , Fibrose/patologia , Humanos , Erupções Liquenoides/patologia , Pessoa de Meia-Idade , Couro Cabeludo/patologiaRESUMO
Abstract: Lupus erythemathosus is a chronic, relapsing disease with acute, subacute, and chronic lesions. Effluvium telogen occurs in the setting of systemic activity of the disease, and cicatricial alopecia results from discoid lesionsin on the scalp. Other types of alopecia, like alopecia areata, may rarely be found in lupus. Frontal fibrosing alopecia is characterized by frontotemporal hairline recession and eybrow loss. Histophatologically, it cannot be differentiated from lichen planopilaris.It is controversial whether frontal fibrosing alopecia is a subtype of lichen planopilaris.. A pacient with chronic lichenoid lupus erythematosus is described with clinical, histophatological and dermoscopic features of frontal fibrosing alopecia.We have not been able to find in the literature cases of frontal fibrosing alopecia as a clinical manifestation of lupus.
Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Lúpus Eritematoso Discoide/complicações , Lúpus Eritematoso Discoide/patologia , Alopecia/complicações , Alopecia/patologia , Couro Cabeludo/patologia , Biópsia , Fibrose/patologia , Erupções Liquenoides/patologia , DermoscopiaRESUMO
Abstract Frontal fibrosing alopecia is a distinctive form of scarring alopecia considered to be a clinical variant of lichen planopilaris. It predominantly occurs in postmenopausal women and has a slowly progressive course. It was first described by Kossard in 1994. Since then the number of reported cases has increased significantly. Coexistence of frontal fibrosing alopecia and autoimmune disorders - such as discoid erythematosus lupus and Sjögren's syndrome - may suggest a common pathogenic background among the diseases.
Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Síndrome de Sjogren/complicações , Alopecia/complicações , Fibrose , Lúpus Eritematoso Discoide/complicações , Lúpus Eritematoso Discoide/patologia , Folículo Piloso/patologia , Derme/patologia , Alopecia/imunologia , Alopecia/patologia , Líquen Plano/imunologia , Líquen Plano/patologiaAssuntos
Doença de Addison/diagnóstico , Lúpus Eritematoso Discoide/diagnóstico , Poliendocrinopatias Autoimunes/diagnóstico , Doença de Addison/complicações , Doença de Addison/tratamento farmacológico , Biópsia , Feminino , Glucocorticoides/uso terapêutico , Humanos , Lúpus Eritematoso Discoide/complicações , Lúpus Eritematoso Discoide/tratamento farmacológico , Pessoa de Meia-Idade , Poliendocrinopatias Autoimunes/complicações , Poliendocrinopatias Autoimunes/tratamento farmacológico , SíndromeRESUMO
Frontal fibrosing alopecia is a distinctive form of scarring alopecia considered to be a clinical variant of lichen planopilaris. It predominantly occurs in postmenopausal women and has a slowly progressive course. It was first described by Kossard in 1994. Since then the number of reported cases has increased significantly. Coexistence of frontal fibrosing alopecia and autoimmune disorders - such as discoid erythematosus lupus and Sjögren's syndrome - may suggest a common pathogenic background among the diseases.
Assuntos
Alopecia/complicações , Síndrome de Sjogren/complicações , Alopecia/imunologia , Alopecia/patologia , Derme/patologia , Feminino , Fibrose , Folículo Piloso/patologia , Humanos , Líquen Plano/imunologia , Líquen Plano/patologia , Lúpus Eritematoso Discoide/complicações , Lúpus Eritematoso Discoide/patologia , Pessoa de Meia-IdadeAssuntos
Edema/etiologia , Eritema/diagnóstico , Eritema/etiologia , Doenças Palpebrais/diagnóstico , Doenças Palpebrais/etiologia , Lúpus Eritematoso Discoide/complicações , Adulto , Doença Crônica , Diagnóstico Diferencial , Edema/diagnóstico , Humanos , Lúpus Eritematoso Discoide/diagnóstico , Pessoa de Meia-IdadeRESUMO
Cutaneous squamous cell carcinoma, the second most common form of non-melanotic skin cancer, may develop in long-standing discoid lesions, especially those that are depigmented and located in sun-exposed areas. The clinical course of this complication may be aggressive, with early metastases and a risk of mortality. We report three cases demonstrating this emerging trend of secondary squamous cell carcinoma in discoid lesions as the incidence of this secondary malignancy in other diseased skin lesions is on the decline.
Assuntos
Carcinoma de Células Escamosas/etiologia , Lúpus Eritematoso Discoide/complicações , Neoplasias Cutâneas/etiologia , Adolescente , Adulto , Carcinoma de Células Escamosas/patologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Metástase Neoplásica , Neoplasias Cutâneas/patologia , Luz Solar/efeitos adversosRESUMO
O lúpus eritematoso discóide é uma desordem autoimune que geralmente afeta áreas da pele expostas ao sol. A apresentação de lesões palpebrais na ausência de outras anormalidades cutâneas é incomum, sendo o envolvimento da pálpebra inferior prevalente em apenas 6% dos pacientes com lúpus eritematoso cutâneo crônico. Relatamos o caso de uma paciente do sexo feminino de 40 anos, com hiperemia, madarose e ulceração na pálpebra inferior do olho esquerdo refratária ao tratamento para blefarite. Inicialmente, outra lesão semelhante havia sido descrita na pálpebra superior do olho direito. No entanto, as biópsias incisionais mostraram-se inconclusivas. Diante de uma lesão migratória palpebral de características semelhantes à primeira, a hipótese clínica de lúpus eritematoso discóide foi aventada e o diagnóstico confirmado por meio de revisão histopatológica. Uma forte suspeita clínica e o reconhecimento precoce podem evitar erros diagnósticos, complicações clínicas e tratamentos inapropriados, como descrito neste caso de lesão palpebral como manifestação primária do lúpus eritematoso discóide.
The discoid lupus erythematosus is an autoimmune disorder which generally affects the sun-exposed skin. Presentation of lesions on the eyelids in the absence of any other cutaneous abnormality is uncommon and the lower-eyelid involvement is seen in 6% of patients with cronic cutaneous lupus erythematosus. We have reported the case of a 40 year-old, woman who presented hyperemia, madarosis and ulceration on the lower eyelid of the left eye. She was treated for blepharitis without resolution. Before that, another similar lesion had been described on the upper eyelid of the right eye. Nevertheless, the incisional biopsies of that eyelid were inconclusive. Faced with a migratory lesion similar to the first one, the clinical hypothesis of discoid lupus erythematosus was suggested and diagnosis was confirmed by histopathological review. A high index of suspicion and early recognition may prevent misdiagnosis, clinical complications and inappropriate treatment, as described in the case of eyelid lesion as a primary manifestation of discoid lupus erythematosus.
Assuntos
Humanos , Feminino , Adulto , Antimaláricos/uso terapêutico , Blefarite/etiologia , Corticosteroides/uso terapêutico , Hidroxicloroquina/uso terapêutico , Hiperemia/diagnóstico , Lúpus Eritematoso Discoide/cirurgia , Lúpus Eritematoso Discoide/complicações , Lúpus Eritematoso Discoide/tratamento farmacológico , Pálpebras/lesões , Protetores Solares/uso terapêutico , Diagnóstico DiferencialRESUMO
As a cutaneous variant of lupus erythematosus, discoid lupus erythematosus (DLE) is thought to have a good prognosis; however, the involvement of internal organs with a transition to systemic disease may occur. The progression from DLE to systemic lupus erythematosus has been reported in up to 28% of patients. This progression to systemic disease has been associated with a benign course. Herein, we report the case of a 31-year-old woman with a 10-year history of discoid lupus, now presenting with dyspnea and pleuritic chest pain of 1 month's duration. A significant drop in hemoglobin and hematocrit levels was observed in association with leukopenia, lymphopenia, a positive ANA, and hypocomplementemia. Chest radiography and computed tomography revealed bilateral infiltrates. An open lung biopsy confirmed the presence of intra-alveolar hemorrhage. Based on the results of the tests and analyses detailed herein, a diagnosis of pulmonary hemorrhage secondary to systemic lupus erythematosus was made. To our knowledge, pulmonary hemorrhage as the initial manifestation of the systemic involvement of discoid lupus has not been reported before.
Assuntos
Hemorragia/etiologia , Pneumopatias/etiologia , Lúpus Eritematoso Discoide/complicações , Adulto , Antibacterianos/uso terapêutico , Biópsia , Broncopneumonia/diagnóstico , Erros de Diagnóstico , Progressão da Doença , Dispneia/etiologia , Feminino , Hemorragia/sangue , Hemorragia/diagnóstico por imagem , Hemorragia/patologia , Humanos , Hidroxicloroquina/uso terapêutico , Leucopenia/etiologia , Pneumopatias/sangue , Pneumopatias/diagnóstico por imagem , Pneumopatias/patologia , Lúpus Eritematoso Sistêmico/complicações , Prednisona/uso terapêutico , Radiografia , Cirurgia Torácica VídeoassistidaRESUMO
El desprendimiento seroso de retina produce disminución de la agudeza visual debido al paso de fluido procedente de la coroides hacia el espacio subretiniano. Esta enfermedad tiene varias causas, entre las que se encuentran las idiopáticas, congénitas, posquirúrgicas, secundarias e uveítis infecciosas, autoinmune, vascular, hematológicas y neoplásicas.Objetivo: describir el caso inusual de un paciente joven con desprendimiento seroso de retina asociado a lupus fijo discoide y nefropatía por inmunoglobulina A con respuesta satisfactoria al uso de esteroides.Caso clínico: se presenta un paciente masculino de 18 años de edad que acudió a consulta de retina del centro oftalmológico del Hospital Universitario Manuel Ascunce Domenech, por disminución súbita de la agudeza visual en ambos ojos con diagnóstico inicial de coroidopatia serosa central, que posteriormente evolucionó hacia desprendimientos serosos bilaterales con afectación de todo el polo posterior. Por sus antecedentes se interconsultó con el especialista en dermatología y nefrología, donde se decidió iniciar tratamiento con esteroides a altas dosis, vitaminoterapia endovenosa, así como antiinflamatorios y midriáticos ciclopléjicos tópicos con respuesta excelente a la terapia
Serous retinal detachment causes visual acuity decrease due to the passage of fluid from the choroid into the subretinal space. This disease has several causes including idiopathic, congenital, postoperative, and secondary to infectious uveitis, autoimmune, vascular, hematological and neoplastic ones.Objective: to describe an unusual case of a young patient with serous retinal detachment associated with discoid fixed lupus and nephropathy by immunoglobulin A with satisfactory response to steroids use.Clinical case: a male patient of 18 years old was presented in the retina office of the Ophthalmological Center at the University Hospital Manuel Ascunce Domenech with sudden decrease of visual acuity in both eyes with an initial diagnosis of serous central choroidopathy, which later progressed into bilateral serous detachments with entire posterior pole involvement. By his antecedents, a specialty consultation in dermatology and nephrology was carried out, deciding to initiate treatment with high-dose steroids, intravenous vitamin therapy, and anti-inflammatory and topical cycloplegic mydriatic with excellent response to therapy
Assuntos
Humanos , Adolescente , Masculino , Anti-Inflamatórios , Descolamento Retiniano/tratamento farmacológico , Glomerulonefrite por IGA/complicações , Lúpus Eritematoso Discoide/complicações , Metilprednisolona/uso terapêutico , Midriáticos/uso terapêutico , Vitaminas/uso terapêuticoRESUMO
Pancreatitis complicating a diagnosis of systemic lupus erythematosus (SLE) is rarely reported in the literature and there are no known published cases thus far in the Caribbean. A 50-year old female diagnosed with SLE and discoid lupus erythematosus (DLE) since 1990, presented in February, 2009, to the University Hospital of the West Indies (UHWI), Kingston, Jamaica, with symptoms suggestive of lupus pancreatitis. Serum amylase level was 2341 IU/L and serum lipase was 203 IU/L. Pancreatitis has a 3-8% rate of occurrence in adult patients with SLE. Aetiology and management of this entity remains controversial in these cases, but one must bear the diagnosis in mind, when faced with a SLE patient presenting with abdominal pain, vomiting and diarrhoea.
La pancreatitis que complica el diagnóstico del lupus eritematoso sistémico (LES), raramente se reporta en la literatura, y hasta hoy no se conoce de caso alguno publicado en el Caribe. Una mujer de 50 años de edad, a quien se le diagnosticara lupus eritematoso sistémico (LES), y lupus eritematoso discoide (LED) desde 1990, acudió en febrero de 2009 al Hospital Universitario de West Indies, Kingston, Jamaica, con síntomas que sugerían una pancreatitis por lupus. El nivel de amilasa sérica fue 2341 IU/L y el de lipasa sérica fue 203 IU/L. La pancreatitis tiene una tasa de ocurrencia de 3-8% en pacientes adultos con LES. La etiología y el tratamiento de esta entidad siguen siendo controversiales en estos casos, pero se debe tener presente el diagnóstico frente a pacientes de SLE que presenten dolor abdominal, vómito y diarrea.
Assuntos
Feminino , Humanos , Pessoa de Meia-Idade , Lúpus Eritematoso Sistêmico/complicações , Pancreatite/etiologia , Amilases/sangue , Jamaica , Lipase/sangue , Lúpus Eritematoso Discoide/sangue , Lúpus Eritematoso Discoide/complicações , Lúpus Eritematoso Sistêmico/sangue , Pancreatite/sangueRESUMO
Pancreatitis complicating a diagnosis of systemic lupus erythematosus (SLE) is rarely reported in the literature and there are no known published cases thus far in the Caribbean. A 50-year old female diagnosed with SLE and discoid lupus erythematosus (DLE) since 1990, presented in February, 2009, to the University Hospital of the West Indies (UHWI), Kingston, Jamaica, with symptoms suggestive of lupus pancreatitis. Serum amylase level was 2341 IU/L and serum lipase was 203 IU/L. Pancreatitis has a 3-8% rate of occurrence in adult patients with SLE. Aetiology and management of this entity remains controversial in these cases, but one must bear the diagnosis in mind, when faced with a SLE patient presenting with abdominal pain, vomiting and diarrhoea.