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Lupus panniculitis in Adult
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Lupus panniculitis in Adult

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Contributors: Edward Li PhD, Lisa Altieri MD, Belinda Tan MD, PhD, Susan Burgin MD
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Synopsis

Lupus panniculitis is considered a rare subtype of chronic cutaneous lupus erythematosus with tender indurated subcutaneous nodules or plaques located most frequently on the face, proximal extremities, breasts, and buttocks, with or without overlying cutaneous changes.

Lupus panniculitis is sometimes termed lupus profundus and can be associated with overlying discoid lupus erythematosus (DLE) in approximately one-third of patients. Lupus panniculitis is thought to be caused by an autoimmune reaction in the deep dermis and adipose tissue. The first stage of lupus panniculitis is active inflammation with painful nodules, followed by the second stage of subcutaneous atrophy that can be cosmetically disfiguring.

Lupus panniculitis, like SLE, occurs more commonly in women. Lupus panniculitis develops in approximately 5% of patients with systemic lupus erythematosus (SLE) but can occur as an isolated disease. Cutaneous manifestations of lupus panniculitis can develop years before or after the diagnosis of SLE. The average age of onset is 30-40s.

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 epithelial 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 types of panniculitis – Requires pathologic tissue examination to differentiate.
  • Tumid lupus erythematosus – Photosensitive distribution of erythematous papules, nodules, and plaques.
  • Lipoatrophy – Associated with history of injected medications or of highly active antiretroviral therapy treatment for HIV.

Best Tests

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Management Pearls

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Therapy

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References

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Last Reviewed: 03/12/2019
Last Updated: 05/31/2019
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Lupus panniculitis in Adult
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Lupus panniculitis : Fever, ANA positive, Leukopenia, Skin ulcer, Alopecia, Subcutaneous nodules, Atrophic scars
Clinical image of Lupus panniculitis
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