BULLOUS LUPUS ERYTHEMATOSUS
By Gary M. White, MD
Rarely, lesions of cutaneous lupus erythematosus may develop blisters.
Vesicles and/or bulla in a patient with systemic lupus erythematosus (SLE), typically a young adult woman, is characteristic. Of course, men and occasionally children may be affected. The bulla are typically subepidermal and have clinical similarities to bullous pemphigoid or dermatitis herpetiformis.
Diagnostic criteria have been proposed [J Am Acad Dermatol 1983;9:924–933]:
- A diagnosis of SLE based upon the American College of Rheumatology criteria.
- Vesicles and bulla arising upon, but not limited to, sun-exposed skin.
- Histopathology compatible with dermatitis herpetiformis.
- Negative indirect immunofluorescence for circulating anti-BMZ antibodies.
- Direct immunofluorescence that reveals IgG or IgM and often IgA at the BMZ.
For a differential, see the bullous differential.
Dapsone is the treatment of choice. Prednisone, azathioprine, and cyclophosphamide are alternatives.
A young man with blisters on the arms for 2 months. Workup showed systemic lupus erythematosus.
Bullous lupus on the trunk of an 8-year-old.
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