Pulsed-dye laser as an adjuvant treatment for discoid lupus erythematosus: a randomized, controlled trial.

PURPOSE: To evaluate the efficacy and safety of pulsed-dye laser (PDL) for discoid lupus erythematosus (DLE) in a double blinded, randomized, controlled fashion. METHOD: Forty-eight DLE lesions from nine patients were recruited. The lesions on one side of the body were randomized into the treatment group and the other side served as a control. Treatments with the PDL (595 nm) were delivered every four weeks for four consecutive months. The patients were evaluated at weeks 0, 4, 8, 12, 16 and 24. Erythema index (EI) and Texture index (TI) were obtained by Antera3D®. Modified Cutaneous Lupus Erythematosus Disease Area and Severity Index (mCLASI) and physician global assessment (PGA) scores were assessed in every visit. Lesional skin biopsies before and after the PDL treatment were taken from four patients. RESULTS: The lesions treated with the PDL demonstrated significantly more decreases in EI, TI and improvement in PGA scores compared to the control. Though there was improvement of mCLASI in the laser group, the significance difference was not observed. Interestingly, real-time polymerase chain reaction showed a reduction in CXCL-9, 10, IFN-γ, IL-1ß, TNF-α and TGF-ß. Additionally, post-treatment DLE lesions demonstrated decreased CD3, CD4, CD8 and CXCR3-positive cells. CONCLUSIONS: Improvements of DLE can be achieved with PDL.

Lesão palpebral como manifestação primária do lúpus eritematoso discóide / Eyelid lesion as a primary manifestation of discoid lupus erythematosus

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.

Efficacy and safety of pulsed dye laser treatment for cutaneous discoid lupus erythematosus.

BACKGROUND: Treatment of chronic discoid lupus erythematosus (CDLE) with a pulsed dye laser (PDL) has shown promising results, although outcomes in previous studies were not validated and laser parameters were inconsistent. OBJECTIVE: We conducted an open prospective study to assess the efficacy and safety of PDL for the treatment of recalcitrant CDLE, using a validated scoring method and a fixed treatment schedule. METHODS: Twelve patients with active CDLE lesions were treated with PDL (585 nm, fluence 5.5 J/cm(2), spot size 7 mm) 3 times with an interval of 6 weeks followed by a 6-week follow-up period. Treatment outcomes were evaluated by 3 observers using the validated Cutaneous Lupus Erythematosus Disease Area and Severity Index (CLASI). Cosmetic results and adverse events were recorded. RESULTS: A significant decline in "active" CLASI was observed after 6 weeks, after 12 weeks, and at follow-up. Baseline active CLASI was 4.4 +/- 0.2 (mean +/- SEM), reaching 1.3 +/- 0.3 after follow-up (P < .0001). Individual scores for erythema and scaling/hypertrophy significantly declined 6 weeks after treatment. The "damage" CLASI (dyspigmentation, scarring, and atrophy) did not show any significant change during or after therapy. The observed clinical improvement was confirmed by two independent observers by clinical assessment of photographs (r = 0.87 and r = 0.89; both P < .05). The treatment was well tolerated, only minimal pain was reported, and the cosmetic result was fair. LIMITATIONS: Small sample size and short follow-up duration were limitations. CONCLUSION: PDL treatment is an effective and safe therapy for patients with refractory CDLE.

A case of discoid lupus erythematosus of the eyelid.

A 39-year-old man was first evaluated 12 years ago for erosive erythema of the left lower eyelid. The response to topical therapy was poor. The eyelid lesion was excised on the patient's demand 6 years ago and blepharoplasty was performed. However, recurrence of erythematous plaques at the same site prompted referral to our department. Examination clinically revealed atrophic erythematous plaques and several white papules on the left lower eyelid, in addition to an atrophic erythema of the upper back. The histopathological findings of both plaques and papules were typical of discoid lupus erythematosus. Immunoserological findings suggestive of systemic lupus erythematosus were absent. The lesions improved with administration of low-dose corticosteroids. Discoid lupus erythematosus involving the eyelid is rare, and definitive diagnosis often takes considerable period of time. In patients with lesions of the eyelid such as erythema or papules that are refractory to treatment, skin biopsy and careful physical examination of the entire body for similar lesions are important.

Epidermal grafting for depigmentation due to discoid lupus erythematosus.

BACKGROUND: Longstanding lesions of discoid lupus erythematosus (DLE) may heal with thin, depigmented scar(s). The depigmentation may fail to respond to medical therapies. OBJECTIVE: To evaluate the efficacy of suction blister epidermal grafting in longstanding, quiescent, depigmented scar(s) of DLE. METHODS: The suction blisters were raised on the lateral aspect of the upper third of the thigh in 4 patients (3 males, 1 female) with depigmented scars of DLE on the face. The roofs of the blisters were transferred to the dermabraded recipient area. Both donor and recipient sites were dressed with nonadherent tulle. RESULTS: The dressings were removed after 7 days. The graft take was complete. The pigmentation achieved was more than 100% of the grafted area due to peripheral spread of the pigmentation and more than 75% of the depigmented area. The color match was good. There was no loss of pigment or recurrence/relapse of the disease during the follow-up of 6 months to 1 year. CONCLUSIONS: Our preliminary results suggest that leukodermic scars of healed inactive DLE lesions can be successfully treated with epidermal grafting.

A simple method for earlobe reconstruction.

We describe a technique for earlobe construction using the V-shaped flap with rotation and transposition techniques. This technique produces a natural appearing lobule without unpleasant secondary deformity. This method has been used on two patients, with very good results.

[Successful treatment of chronic discoid lupus erythematosus with argon laser]. / Erfolgreiche Behandlung des chronisch diskoiden Lupus erythematodes mittels Argon-Laser.

We report on a patient with chronic discoid lupus erythematosus who was treated with argon-laser. The patient suffered from long-standing lesions and had been pretreated with various drugs; with no or slight improvement. After a few argon-laser applications, the treated skin lesions improved dramatically while the untreated lesional skin showed continuous disease activity. Histological and immunohistological investigations of biopsies from treated and untreated lesional skin suggest that endothelial mechanisms play a role in the generation and maintenance of discoid lesions in lupus erythematosus. This is the first reported case of successful treatment of chronic discoid skin lesions of a lupus erythematosus patient with argon-laser.

[Cryogenic contact therapy of cutaneous lesions of lupus erythematosus]. / Kryokontakttherapie kutaner Läsionen beim Lupus erythematodes.

We report about results in cryo-contact therapy of otherwise resistant cutaneous lesion in lupus erythematosus (LE). Important unwanted side-effects are persistent telangiectasias. Nevertheless, cryo-contact therapy is preferable for selected cutaneous LE lesions.

Laser treatment of discoid lupus (case report).

This is a case report of vaporization of the characteristic disfiguring plaques of discoid lupus erythematosus (DLE) with the carbon dioxide laser. This patient had a dramatic clinical and cosmetic improvement. It is suggested that the altered but not vaporized cells that remained were responsible for the retardation of the disease process.

Nasal reconstruction in discoid lupus erythematosus.

The pathophysiology of discoid lupus erythematosus is presented, along with a case of nasal reconstruction using a variety of techniques.

Local excision in the treatment of oral discoid lupus erythematosus.

Oral lesions in eight patients with discoid lupus erythematosus (DLE) were treated with local excision. Ten well-demarcated oral lesions were excised and a primary closure was obtained following the excision. Six patients out of seven became symptom-free following the treatment. The median observation time was 1.0 year. The follow-up examination showed erythema in one case and recurrence in one case at the operation site. In the remaining eight operation sites, a soft scar with no sign of recurrence was seen. These results indicate that the method should be investigated further in order to obtain long-term results. Local excision of oral discoid lesions may be a valuable therapeutic supplement in some cases of DLE.