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Lupus panniculitis in Child
Other Resources UpToDate PubMed

Lupus panniculitis in Child

Contributors: Edward Li PhD, Shelley D. Cathcart MD, Belinda Tan MD, PhD, Susan Burgin MD
Other Resources UpToDate PubMed

Synopsis

Lupus panniculitis is a form of chronic cutaneous lupus erythematosus characterized by firm subcutaneous nodules and plaques. Although the lesions of lupus panniculitis can involve the face, upper arms, trunk, buttocks, and legs, there is a predilection for facial involvement in the pediatric population. The affected areas tend to be asymptomatic and may or may not have associated overlying cutaneous changes. The lesions resolve over time, resulting in subcutaneous atrophy that can be disfiguring.

This entity is rare in the pediatric population, and its exact prevalence is unknown. The mean age of onset is 8 years old among those cases reported. Most patients do not have concurrent systemic lupus erythematosus (SLE), and extensive laboratory evaluation is not indicated in the absence of systemic symptoms.

Codes

ICD10CM:
L93.2 – Other local lupus erythematosus

SNOMEDCT:
239888002 – Lupus panniculitis

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

  • Morphea – Usually presents with purplish borders, fewer nodules, and less facial involvement.
  • Sarcoidosis – Less induration, more epidermal changes.
  • Subcutaneous panniculitis-like T-cell lymphoma (SPTCL) – Can present similarly both clinically and histologically to lupus panniculitis. Clinical features favoring SPTCL include the presence of systemic symptoms, leukopenia, and a high erythrocyte sedimentation rate. On histopathology, the presence of a polyclonal T-cell infiltrate, mixed CD4/CD8 population, and negative T-cell gene rearrangement studies all favor the diagnosis of lupus panniculitis over SPTCL. Lupus panniculitis lesions contain a higher percentage of CD123-positive plasmacytoid dendritic cells compared to SPTCL.
  • Other panniculitides – Requires pathologic tissue examination to differentiate. See panniculitis.

Best Tests

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Management Pearls

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Therapy

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References

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Last Reviewed:03/11/2019
Last Updated:05/30/2019
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Lupus panniculitis in Child
Lupus panniculitis : Fever, ANA positive, Leukopenia, Skin ulcer, Alopecia, Subcutaneous nodules, Tender skin lesions, Atrophic scars
Clinical image of Lupus panniculitis
A depressed, erythematous plaque with central scale on the arm.
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