By Gary M. White, MD
Also known as lupus panniculitis, lupus erythematosus profundus is an unusual variant of cutaneous lupus erythematosus that is characterized by chronic, recurrent inflammation of the underlying fat leading to nodules, lipoatrophy and significant depression.
Lipoatrophy, deep subcutaneous nodules, and/or morphea-like lesions may occur most commonly on the upper arm, breasts, thighs, buttocks, and face. The overlying skin may be normal or show DLE lesions.
The usual workup and labs for lupus should be performed.
Hydroxychloroquine 200 QD-BID is usually given until control is achieved and then the dose tapered over months as able. Disease-free periods may occur with occasional relapses. Rituximab has been used successfully [Dermatol Therapy 2013:26;415-8]. Prednisone and dapsone have been used. For related therapy, see cutaneous lupus erythematosus.
Note the atrophic lesion in the upper left as well.
Typical location on the upper outer arm.
Deep-seated nodules on the upper outer arm.
Livedo erythema and ulceration.
Punched out ulcer.
Indian J Dermatol Venereol Leprol 2014;80:275-7
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