Tumid Lupus Erythematosus

Excerpt

Cutaneous lupus erythematosus (CLE) can present in three forms: acute cutaneous lupus erythematosus (ACLE), subacute cutaneous lupus erythematosus (SCLE), and chronic cutaneous lupus erythematosus (CCLE). CCLE can be further be subdivided into chronic subtypes consisting of tumid lupus erythematosus (TLE), discoid lupus erythematosus (DLE), chilblain lupus erythematosus, and lupus panniculitis. Although these forms possess morphologies and histological features distinct from one another, more than one form can co-exist in the same patient.

Although tumid lupus erythematosus (TLE) is currently considered to be a subtype of cutaneous lupus erythematosus (CLE), TLE differs from the other subtypes of cutaneous lupus erythematosus in that an association with systemic lupus erythematosus (SLE) is rare. Because of this weak association with SLE and a relative lack of serologic abnormalities in patients with TLE, some consider TLE to be an entity separate from lupus. It has also been postulated that TLE is in the same spectrum as lymphocytic infiltrate of Jessner and reticular erythematous mucinosis (REM) due to similar findings on histology.

Tumid lupus erythematosus (TLE) typically presents as annular, indurated, erythematous, edematous papules and plaques without epidermal involvement. If any of these features are recognized, and epidermal involvement is likely, a diagnosis of DLE should be suspected. Typical locations of TLE are the face and trunk, and lesions respond well to photoprotection, topical corticosteroids, and antimalarials.