Differential Diagnosis

Systemic lupus erythematosus: Often involves kidneys and central nervous system; lesions less likely to be papulosquamous or annular; not as often associated with positive RO (SS-A) antigen.

Discoid lupus erythematosus: See Table. .25-1.

Erythema annulare centrifigum: Often is singular lesion without follicular plugging or telangiectasia; lesions are circinate and may have fine adherent scale and clearing in center; may be related to underlying illness but not usually lupus erythematosus; ANA test is negative and patients are not photosensitive; skin biopsy may be diagnostic and direct immunofluorescence is negative (see Dictionary-Index).

Psoriasis: Silvery white, thick adherent scale usually improves with sun exposure; common on elbows, knees, scalp, and intertriginous locations; histology often nonspecific but negative lupus band; may be associated with arthritis (7%) but other organs spared and ANA test negative.

Vitiligo: Not associated with previous inflammatory stage and photosensitive only in areas of pigment loss; negative ANA blood test and not associated with arthritis. TREATMENT

A young woman presents with photosensitivity, arthritis, and skin lesions thought to represent psoriasis. A blood test reveals SS-A antigen.

1. It is necessary to evaluate other organ systems (kidney, central nervous system, liver, lung) even though joint and skin diseases are probably the only involvement.

2. Photosensitivity drug eruption should be checked for and a potent sunscreen considered.

3. Topical corticosteroids and oral antimalarial agents are first-line therapies. Systemic corticosteroids and immunosuppressive drugs (azathioprine, cyclophosphamide) should be used only in severe cases.

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