Acute CLE

  • >90% risk of SLE

  • Bilateral malar erythema “butterfly rash”
    • Transient erythema ± edema ± dyspigmentation, scales, telangiectasia, erosions, atrophy
    • Spare nasolabial fold (vs. dermatomyositis)
    • Resolve without scarring
  • Hand erythema – knuckles spared
  • Oral ulcers
  • Widespread erythema (favoring photoexposed sites)

  • Rowell’s Syndrome: overlap with erythema multiforme
    Bullous SLE

    • Histopathology resembles dermatitis herpetiformis with neutrophilic microabscesses in dermal papillae plus immunoreactants at the basement membrane zone ± type VII collagen antibodies
  • TEN-like
  • Drugs-induced SLE
    • (Arthralgias, myalgias, pleuritis, pericarditis and fever; NO nephritis or CNS, rarely acute CLE, anti-histone and anti-dsDNA antibodies)

  • Vacuolar alteration of basal layer, apoptotic keratinocytes, epidermal atrophy ± basement membrane thickening
  • Lymphocytic infiltrate in upper dermis
  • Dermal edema, dermal mucin, focal hemorrhage

  • Rosacea
  • Seborrheic dermatitis
  • Sunburn
  • Drug-induced photosensitivity (phototoxic, photoallergic)
  • Dermatomyositis
  • Erysipelas
  • Pemphigus
  • Atopic dermatitis
  • Contact dermatitis
  • Photocontact dermatitis