French Dermatologist Pierre Louis Alphée Cazenave


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Lupus erythematosus:

-Was described by the French Dermatologist Pierre Louis Alphée Cazenave in the 19th Century
-“Lupus” comes from the Latin meaning “wolf”. It implies ulcerations (which are not always present) as meaning “bitten by a wolf” it is therefore a misnomer.
-It is an autoimmune disease and its cause remains unknown. However drugs like minocycline can induce lupus erythematosus.
In practice three cases often present to the dermatologist (although presentations vary):
-Acute or Systemic form: Combination of skin findings (malar erythema (“butterfly rash”), photosensitivity (sunburnt easily), oral ulcerations) and arthralgia (joint pain).
-Subacute form: Usually presence of annular lesions. Important to identify in pregnant women as neonatal lupus can lead to heart block.
-Discoid or Chronic form: usually presents with rough feeling (“grater-like”) plaques which can be anywhere but often on the scalp (a possible cause of scarring alopecia).
Diagnosis is made by biopsy and blood tests.
Biopsy shows a thickened basement membrane. An interesting study about this is available here: http://www.ncbi.nlm.nih.gov/pubmed/15462489
Anti nuclear antibodies are useful for the diagnosis and for monitoring activity of the disease.
Systemic treatment options are varied (analgesics, steroids, antimalarals, azathioprine, methotrexate…)