Acute cutaneous lupus erythematosus (ACLE)

Synonym (s)

ACLE.

Definition

Initial form of cutaneous lupus erythematosus.

Epidemiology

Typical first manifestation at the age of 20-50 years.

Etiopathogenesis

UV exposure.

Clinical features

Classic butterfly erythema, may scale somewhat.
No scars are found after healing of the butterfly rash, but there may be pigmentary ageing (scars are found after discoid lupus lesions).

Diagnosis

see cutaneous lupus erythematosus.
Note: In ACLE, serological work-up is usually non-specific. SS-A/B and dsDNA antibodies may be positive.

Localization

UV-exposed areas, especially face (cheeks, eminence-based one sees recesses of the nasolabial folds, though not always). May also affect trunk and extremities.

Dermatopathology

see cutaneous lupus erythematosus.

Therapy

see cutaneous lupus erythematosus.

Avoid common mistakes:

History should always include photosensitivity.
Medication history to rule out "drug-induced" lupus erythematosus.
Family and self history for autoimmune disease.
Avoid a purely superficial biopsy.
Therapy should not be changed until preventive measures to avoid possible trigger factors have been exhausted and sunscreen with a high sun protection factor is applied daily!

References

Walling HW, Sontheimer RD. Cutaneous lupus erythematosus: issues in diagnosis and treatment. Am J Clin Dermatol 2009;10:365-81.
Okon LG, Werth VP. Cutaneous lupus erythematosus: diagnosis and treatment. Best Pract Res Clin Rheumatol 2013;27:391-404.
Kuhn, A. (2016). S1-Leitlinie: Kutaner Lupus Erythematodes. Awmf.org. Retrieved 30 May 2016, from http://www.awmf.org/leitlinien/detail/ll/013-060.html