Cutaneous Lupus Erythematosus PDF
Preview Cutaneous Lupus Erythematosus
Annegret Kuhn.Percy Lehmann.Thomas Ruzicka (Eds.) Cutaneous Lupus Erythematosus . . Annegret Kuhn Percy Lehmann Thomas Ruzicka (Eds.) Cutaneous Lupus Erythematosus With 60 Figures and 42 Tables 1 3 Priv.-Doz.Dr.AnnegretKuhn UniversitätsklinikumDüsseldorf Hautklinik Moorenstraße5 40225Düsseldorf,Germany Prof.Dr.Percy Lehmann UniversitätsklinikumWitten-Herdecke HELIOSKlinikumWuppertal Klinikfür Dermatologie,Allergologie undUmweltmedizin Arrenbergerstraße 20 42117 Wuppertal,Germany Prof.Dr.Dr.h.c.Thomas Ruzicka UniversitätsklinikumDüsseldorf Hautklinik Moorenstraße5 40225Düsseldorf,Germany ISBN 3-540-44266-9 Springer-VerlagBerlinHeidelbergNew York Library ofCongress Cataloging-in-PublicationData Cutaneous lupus erythematosus / [editedby]Annegret Kuhn,Percy Lehmann,Thomas Ruzicka.p.; cm. Includes bibliographical references andindex. ISBN 3-540-44266-9(alk.paper) 1.Lupus erythematosus.I.Kuhn,Annegret,1967- II.Lehmann,Percy,1953- III.Ruzicka,Thomas. [DNLM:1.Lupus Erythematosus,Cutaneous–patholgoy. 2.Lupus Erythematosus,Cutaneous–therapy.WR152 C988 2004] This workis subjecttocopyright.All rights are reserved,whether the wholepartofthematerialis concerned, specifically the rights oftranslation,reprinting,reuseofillustrations,recitation,broadcasting,reproduction onmicrofilmorinany other way,and storageindatabanks.Duplicationofthis publicationor parts thereof is permittedonly under provisions oftheGermanCopyright Law ofSeptember 9,1965,inits current version, andpermissionforusemust always beobtainedfromSpringer-Verlag.Violations areliableforprosecution under theGermanCopyright Law. Springer is apartofSpringer Science+Business Media springeronline.com ©Springer-VerlagBerlin·Heidelberg 2005 PrintedinGermany The useofgeneraldescriptivenames,registerednames,trademarks,etc.in this publicationdoes not imply, evenin theabsenceofa specific statement,that suchnames areexempt fromthe relevantprotectivelaws and regulations and thereforefreeforgeneral use. Product liability:Thepublishers cannot guarantee theaccuracyofanyinformationaboutdosageandappli- cationcontainedin this book.Ineveryindividualcase the user must check suchinformationby consulting the relevantliterature. Editor:MarionPhilipp DeskEditor:IrmelaBohn Production:PROEdit GmbH,69126 Heidelberg,Germany Typesetting:SDS,Leimen,Germany Cover design:ErichKirchner,69121Heidelberg,Germany 24/3150/beu-göh–543210 –Printedonacid-freepaper Foreword Acomprehensive,in-depthmonograph suchas this focusedentirely onthe subject of thecutaneous manifestations oflupus erythematosus (LE)is longoverdue! LEisincreasinglybeingrecognizedasamorecommonautoimmunedisorderthan was previously thought,and thecutaneous manifestations ofLEareamong themost commonclinicalfeatures ofLEatits onset and throughoutits course.Themost com- monly recognized environmental risk factor for LE,ultraviolet light exposure from sunlightandartificial sources,necessarily transduces its disease-exacerbatingeffect through the skin.Cutaneous LEcanbeasignificant contributor topsychosocialand occupationaldisability.Inaddition,the universally recognized symbols of LE– the butterfly and the wolf– relatetodifferent cutaneous manifestations ofLE. Yet,the skinhas been theleast well-studiedorgan system that is affectedbyLE. This has resultedfrom the relative“invisibility”ofthe skinand skindisease tonon- dermatologists whodeal withpatients withLE.After all,“it’s only arash.”Perhaps this wouldbeless ofaproblemifnondermatologist physicians werebetter trainedin the principles andpracticeofrecognizingandmanaging skindiseases during their for- malmedicaleducation.Also,contributing to this is thefactthat expertmanagement ofLEand rheumatic skindiseaseingeneralareatriskofbeinglost from thederma- tologist’srepertoirein someparts ofthe world,including theUnitedStates. However,toarelatively small subset ofacademicdermatologists who subspecial- izein thecutaneous manifestations ofLE,theproteanchanges thatcanoccur in the skinofpatients withLEcanbebothfascinatinganddaunting.Howasingledisease process plays out somany different themes ina singleorgan systemis truly amazing! This matrix becomes evenmorecomplex whenoneconsiders the relationships that exist between the various morphologic varieties of skinchangeinpatients withLE and the various systemicmanifestations ofLE.Muchis yet tobelearnedin this area! Weareindeedfortunatethat Drs.Kuhn,Lehmann,andRuzickahaveassembleda highly experiencedandexpertgroupof individuals toaddress the various subjects presentedin this monograph.Frommyperspective,this has beenawonderful,soup- to-nuts tour ofour currentunderstandingofallmajor aspects ofLE skindisease.It is my hope that this effort willcatalyzefurther thought andprogress in this area. IowaCity,Iowa,USA RichardD.Sontheimer June 2004 Preface Lupus erythematosus (LE)is achronicinflammatory autoimmunediseasecharacter- izedby a wide spectrumofmanifestations anda variableevolution.The skinis one ofthemost frequent sites ofinvolvement,and thus it has longbeencentral tothecon- ceptual framework that physicians have used to deal with this disease.During the past few decades,themechanisms ofcutaneous LEhavebeen under activeinvestiga- tion,and many clinicians and scientists around the world have spent considerable time studying thecutaneous manifestations ofthis disease.This researchhas led to theidentificationofsubsets ofLEdefinedby constellations ofclinicalandphotobio- logical features,histologic and immunopathologic changes,and laboratory abnor- malities.Besides the classic forms such as subacute cutaneous LE and discoid LE, there are uncommon variants that often lead to diagnostic difficulties. Therefore, therehas longbeenaneedforabookonthecutaneous manifestations ofLE thatpro- vides not only acomprehensivedescriptionofthegreat variety ofcutaneous abnor- malities but alsoa synthesis ofour knowledgeofthe relationshipbetweencutaneous and systemicchanges.Furthermore,thecutaneous manifestations ofthis diseaseare a reflection of very specific and also nonspecific immunopathologic events along withinflammatory responses,andmajor progress has beenmadein recentyears in our knowledgeofthe skinas animmunologicorgan.Manyadvances havealsobeen madein understanding theinductionofskinlesions ofLEbyultraviolet light com- bined withalterations in selectins andadhesionmolecules contributing to theaccu- mulationofinflammatory cells in this disease.Animalmodels ofLEhavefurther pro- vided insight into the contributing roles of various T-cell subsets.In addition,the management ofcutaneous manifestations ofLEis challenging,andalthoughconven- tional topical and systemic therapy exists new treatment options have been intro- ducedfor patients with resistantdisease. Cutaneous Lupus Erythematosusis writtenby leadingclinicians and scientists ina multidisciplinary effort and includes chapters on the clinical aspects, pathologic characteristics,andmanagement ofthis disease.Thecombinationofthelatest clini- cal and scientific data supplemented with colour reproductions of the clinical and pathologicchanges ofthe skinprovides acomprehensive summary ofinformationon cutaneous LE. This book acquaints dermatologists, rheumatologists, and general physicians with the skinmanifestations of LE,and wefurther hope that Cutaneous LupusErythematosuswillbea valuable resourcefor allclinicians whodiagnose,treat, andmanagepatients with this disease.Theeditors wouldlike to thankallauthors for their significant contribution to accomplish this book. In addition, the editors dedicatethis book to thememoryoftheir mentor,colleague,andfriendDr.Günther VIII Preface Goerz, Professor of Dermatology, University of Düsseldorf, Germany, who taught them that LEis exciting,complex,and worth spendingalifetime studying. DüsseldorfandWuppertal,Germany Annegret Kuhn June 2004 PercyLehmann Thomas Ruzicka Contents PartI Introduction 1 Whatis Autoimmunity:BasicMechanismsandConcepts . . . . . . . . . . 3 Thomas M.Herndon,GeorgeC.Tsokos 2 Photoimmunology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19 StefanBeissert,AnnetteMehling,Thomas Schwarz 3 TheEpidemiologyofLupusErythematosus . . . . . . . . . . . . . . . . . . 33 SòniaJiménez,RicardCervera,MiguelIngelmo,JosepFont 4 HistoricalBackgroundofCutaneousLupusErythematosus . . . . . . . . . 45 Percy Lehmann PartII ClassificationandClincialAspects ofCutaneous Lupus Erythematosus 5 ClassificationofCutaneous Lupus Erythematosus . . . . . . . . . . . . . . 53 AnnegretKuhn,Thomas Ruzicka 6 ClinicalManifestationsofCutaneousLupusErythematosus. . . . . . . . . 59 AnnegretKuhn,RichardD.Sontheimer,Thomas Ruzicka 7 NonspecificCutaneous Manifestations ofSystemicLupus Erythematosus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 93 Thomas T.Provost 8 Cutaneous Lupus Erythematosus During theNeonatal andChildhoodPeriods. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 107 LelaA.Lee 9 Drug-InducedLupusErythematosus . . . . . . . . . . . . . . . . . . . . . . 117 JackUetrecht 10 AssociationofCutaneous Lupus Erythematosus withOther DermatologicalDiseases . . . . . . . . . . . . . . . . . . . . . . 133 KyrillPramatarov,NikolaiTsankov 11 ClinicalDifferentialDiagnosis ofCutaneous Lupus Erythematosus. . . . . 147 FlorianWeber,Peter Fritsch 12 PhotosensitivityinLupusErythematosus . . . . . . . . . . . . . . . . . . . 161 Percy Lehmann,AnnegretKuhn 13 RelationshipBetweenCutaneous andSystemicLupus Erythematosus . . . 177 ChristofSpecker,MatthiasSchneider 14 PrognosisofCutaneousLupusErythematosus . . . . . . . . . . . . . . . . 187 BeateTebbe,ConstantinE.Orfanos X Contents PartIII Pathogenesis andPathologicFeatures ofCutaneous Lupus Erythematosus 15 Molecular Genetics ofCutaneous Lupus Erythematosus . . . . . . . . . . . 205 Thomas P.Millard 16 ExperimentalModelsofLupusErythematosus . . . . . . . . . . . . . . . . 221 FukumiFurukawa 17 ApoptosisinLupusErythematosus. . . . . . . . . . . . . . . . . . . . . . . 239 FelipeAndrade,AntonyRosen,LiviaA.Casciola-Rosen 18 Pathogenesis ofCutaneous Lupus Erythematosus: TheRoleofUltravioletLight. . . . . . . . . . . . . . . . . . . . . . . . . . . 251 MicheleL.Rosenbaum,VictoriaP.Werth 19 TheRoleofTCells andAdhesionMolecules inCutaneous Lupus Erythematosus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 267 FilippaNyberg,EijaStephansson 20 TheRoleofDendriticCells inCutaneous Lupus Erythematosus. . . . . . . 283 Andreas Wollenberg,StefanieWetzel 21 HistologicFindingsinCutaneousLupusErythematosus. . . . . . . . . . . 297 ChristianA.Sander,Amir S.Yazdi,MichaelJ.Flaig,Peter Kind 22 ImmunopathologyofCutaneousLupusErythematosus . . . . . . . . . . . 305 MichaelMeurer 23 LaboratoryFeaturesofCutaneousLupusErythematosus. . . . . . . . . . . 311 ShuntaroShinada,DanielJ.Wallace 24 Antinuclear Autoantibodies inCutaneous Lupus Erythematosus: BiochemicalandCellBiologicalCharacterizationofRo/SSA. . . . . . . . . 323 AnnavonMikecz PartIV Treatment andManagement ofCutaneous Lupus Erythematosus 25 TopicalTreatmentofCutaneousLupusErythematosus. . . . . . . . . . . . 337 Percy Lehmann 26 Antimalarials . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 347 FalkR.Ochsendorf 27 DapsoneandRetinoids. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 373 DavidBacman,AnnegretKuhn,Thomas Ruzicka 28 ThalidomideinCutaneousLupusErythematosus. . . . . . . . . . . . . . . 391 YousufKarim,MariaJ.Cuadrado 29 ImmunosuppressiveDrugs inCutaneous Lupus Erythematosus. . . . . . . 403 MichaelSticherling 30 ExperimentalTherapiesinCutaneousLupusErythematosus . . . . . . . . 419 StefanW.Schneider,Thomas A.Luger 31 ManagementofCutaneousLupusErythematosus. . . . . . . . . . . . . . . 437 JeffreyP.Callen Acknowledgements. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 445 SubjectIndex . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 447 List of Contributors Andrade,Felipe,M.D.,Ph.D. Cervera,Ricard,M.D. InstitutoNacionaldeCiencias UniversityofBarcelona Medicas y Nutricion “Salvador Zubiran” HospitalClinic DepartmentofImmunology DepartmentofAutoimmuneDiseases andRheumatology Villarroel,170 VascodeQuiroga15 08036 Barcelona,Catalonia Mexico,D.F.14000 Spain Mexico Cuadrado,MariaJ.,M.D.,Ph.D. Bacman,David,M.D. St.Thomas Hospital UniversityofDüsseldorf TheRayneInstitute DepartmentofDermatology Lupus ResearchUnit Moorenstraße5 LondonSE1 7EH 40225Düsseldorf UnitedKingdom Germany Flaig,MichaelJ.,M.D. Beissert,Stefan,M.D. Ludwig-Maximilians-University UniversityofMünster DepartmentofDermatology DepartmentofDermatology Frauenlobstraße9–11 Von-Esmarch-Straße58 80337 München 48149Münster Germany Germany Font,Josep,M.D. Callen,Jeffrey P.,M.D. UniversityofBarcelona UniversityofLouisville HospitalClinic SchoolofMedicine DepartmentofAutoimmuneDiseases DepartmentofDermatology Villarroel,170 310 East Broadway,Suite200 08036 Barcelona,Catalonia LouisvilleKY40202 Spain USA Fritsch,Peter,M.D. Casciola-Rosen,LiviaA.,Ph.D. UniversityofInnsbruck JohnHopkins University DepartmentofDermatology SchoolofMedicine Anichstraße 35 Departments ofMedicineandDermatology 6020 Innsbruck 5200 EasternAvenue Austria Baltimore,Maryland 21224 USA
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