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LETTER TO EDITOR
Year : 2019  |  Volume : 18  |  Issue : 3  |  Page : 176-177  

Do skin lesions in the young sound an alarm


Department of General Medicine, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India

Date of Web Publication14-Aug-2019

Correspondence Address:
Dr. Anupam Dey
Room No. 422, Academic Block, All India Institute of Medical Sciences, Sijua, Bhubaneswar - 751 019, Odisha
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/aam.aam_39_18

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How to cite this article:
Dey A. Do skin lesions in the young sound an alarm. Ann Afr Med 2019;18:176-7

How to cite this URL:
Dey A. Do skin lesions in the young sound an alarm. Ann Afr Med [serial online] 2019 [cited 2019 Oct 23];18:176-7. Available from: http://www.annalsafrmed.org/text.asp?2019/18/3/176/264313



Sir,

Systemic lupus erythematosus (SLE) is predominantly a disorder of females. Males including adolescents are rarely affected. Juvenile SLE is usually a more aggressive disease than adult SLE. One such juvenile was seen by the author who had few atypical manifestations.

A 16-year-old male presented with a history of intermittent scattered skin lesions over scalp, ears, back, and lateral part of arm over preceding 2 years. He had not taken any treatment for these lesions. For the last 1 month, he started having intermittent episodes of fever along with painful oral ulcers and flare of the skin lesions over extremities and trunk. After that, he sought medical attention. There was no abnormal bleeding, cough, headache, or weight loss. He also complained of intermittent pain in both knees. Clinical examination showed blood pressure of 109/64 mmHg, and absence of pallor, icterus, lymphadenopathy, or clubbing. Skin examination revealed scattered discoid lesions (pigmented raised border with central atrophy and depigmentation) [Figure 1] and [Figure 2]. There was diffuse hair fall with atrophic scars [Figure 3]. Earlobes had atrophic scars. Hard palate showed erosions [Figure 4] and the lower lip had single erosion. Systemic examination did not reveal any abnormal findings in the chest, cardiovascular, abdomen, and nervous system. Hemoglobin was 8.8 gm%, total leukocyte count 3900, and platelets were 2.87 lakhs. Liver and kidney function tests were normal. Antinuclear antibody and dsDNA were positive. Urine did not show any casts or albumin. The patient was treated as a case of SLE with steroids.
Figure 1: Scattered discoid lesions (pigmented raised border with central atrophy and depigmentation) over the upper limb

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Figure 2: Discoid lesions over the back

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Figure 3: Diffuse hair fall with atrophic scars over the scalp

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Figure 4: Erosions over the hard palate

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SLE is a multisystem disorder of autoimmune etiology characterized by the presence of autoantibodies against self-proteins. It is more common in females of childbearing age with reported female: male ratio of 8–15:1.[1] Male lupus is a rare phenomenon. Predominance in females may be the effect of endogenous sex hormones exerting their effects on the immune system; however, the exact cause is not known.[2] There are studies comparing the differences in clinical features in males versus females. It has been reported that male patients had more renal involvement, neurological involvement, thrombotic episodes, arthritis, and cardiovascular involvement.[3] Male SLE patients are usually older at disease onset as compared to females.[4] The mean age range to experience first SLE-related symptoms in males has been reported to be 26–38.4 years.[5] Males were found to have significantly less photosensitivity, oral ulcers, thrombocytopenia, or increased erythrocyte sedimentation rate in comparison with women in one study.[6] Thus, this is one of the rare instances where SLE has affected a juvenile male and led to the relatively uncommon involvement of skin and oral cavity without other significant systemic involvement. Early diagnosis could have prevented progression of lesions. Hence, we must be careful about atypical manifestations of SLE.

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Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Lu LJ, Wallace DJ, Ishimori ML, Scofield RH, Weisman MH. Review: Male systemic lupus erythematosus: A review of sex disparities in this disease. Lupus 2010;19:119-29.  Back to cited text no. 1
    
2.
Lahita RG. Gender disparity in systemic lupus erythematosus, thoughts after the 8th international congress on systemic lupus erythematosus, Shanghai, China, 2007. J Clin Rheumatol 2008;14:185-7.  Back to cited text no. 2
    
3.
Stefanidou S, Benos A, Galanopoulou V, Chatziyannis I, Kanakoudi F, Aslanidis S, et al. Clinical expression and morbidity of systemic lupus erythematosus during a post-diagnostic 5-year follow-up: A male: Female comparison. Lupus 2011;20:1090-4.  Back to cited text no. 3
    
4.
Wallace DJ, Hahn BH, editors. Dubois' Lupus Erythematosus. 6th ed. Philadelphia: Lippincott Williams and Wilkins; 2002.  Back to cited text no. 4
    
5.
Jacobsen S, Petersen J, Ullman S, Junker P, Voss A, Rasmussen JM, et al. A multicentre study of 513 Danish patients with systemic lupus erythematosus. I. Disease manifestations and analyses of clinical subsets. Clin Rheumatol 1998;17:468-77.  Back to cited text no. 5
    
6.
Voulgari PV, Katsimbri P, Alamanos Y, Drosos AA. Gender and age differences in systemic lupus erythematosus. A study of 489 Greek patients with a review of the literature. Lupus 2002;11:722-9.  Back to cited text no. 6
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]



 

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