Lupus erythematosus tumidus: Case report

Abstract

Introduction Lupus erythematosus tumidus (LET) - a rare chronic inflammatory skin disorder that usually affects sun-exposed areas[1] . Roughly 50% experience rashes with itching, burning, and sensitivity to light [2]. Patients need to be monitored for side effects and potential relapses while treatment progresses from topical corticosteroids to antimalarial drugs [3]. Aim 19-year-old patient developed a facial rash, followed by a rash on elbows and toe. Week before, he had a fever of 38 oC, weakness, fatigue. Prior to this he had been exposed to direct sunlight. Objectively 0,3-1,5 cm in diameter reddish papules and plaques were observed on the cheeks, nose, diffusely distributed 2-4 mm papules on both elbows, and a 1 cm pinkish plaque on the left foot‘s 1st toe. Negative direct immunofluorescence and histology showed hyperkeratotic epidermal tissue fragments, edema in the papillary dermis, superficial and deep perivascular lymphocytic infiltration, abundant mucin deposits between collagen fibres, which indicated a superficial and deep perivascular dermatitis, compatible with Lupus tumidus diagnosis. Blood cell count, general urine test, ALT, AST, creatinine, creatine kinase, ferritin, ESR, CRP – all within normal limits. ANA, ANCA - negative. For systemic treatment Hydroxycloroquine 200 mg dose was prescribed twice a day for 4 months, later 200 mg once a day for 2 months. Topical treatment was started with Mometazone furoate 0.1 % cream once a day, but after 2 weeks steroid acne developed and it was changed to Tacrolime 0.1 % oitment once per day for 6 weeks. The rash had completely disappeared 2 months after the start of the treatment. 10 months post complition of systemic therapy, the rash had not recurred. Conclusion All LET patients are advised sun protection. Combining it with topical glucocorticoids yields positive results. However, Hydroxychloroquine is considered the first-line treatment for LET, especially in cases where topical corticosteroids are ineffective or contraindicated.