Lupus erythematosus
Lupus erythematosus is a dermatological chronic disease with pronounced manifestations on the skin. The etiology of lupus erythematosus is unknown, but its pathogenesis is associated with disorders of the autoimmune system.
The content of the article:
Pathogenesis and causes of lupus erythematosus
Symptoms of lupus erythematosus
Diagnosis of lupus erythematosus
Treatment of lupus erythematosus
Lupus erythematosus
For the first time, the clinical picture of lupus erythematosus was described in detail in the first half of the 19th century. Its name in Latin comes from “erythematosus” — red and “lupus” — wolf. The external signs of the disease are similar to the consequences of a wolf bite. Later, some researchers noted that in some patients with lupus erythematosus, diseases of internal organs were also observed. A few years later, lupus erythematosus was classified, after which there was evidence that the course of systemic lupus erythematosus may not have symptoms on the skin.
Identification of patients with this disease was carried out in the middle of the 20th century. Thanks to the research, it became possible to create a testing system that is still in operation today, helping to identify and identify lupus erythematosus.
As mentioned above, the etiology of this disease is unknown, but it is absolutely established that this is a disease with a complex pathogenesis. In modern medicine, lupus erythematosus is divided into two forms: discoid and systemic. Regardless of the form, the disease proceeds with the same symptoms: the mucous membrane of the mouth and the lip border are affected. In rare cases, spot lesions of the mucous membrane are observed.
Lupus erythematosus is most often observed in people aged 20-45 years, mainly in women. Modern medicine classifies lupus erythematosus into the category of autoimmune and rheumatic diseases.
Pathogenesis and causes of lupus erythematosus
The pathogenesis of this disease is expressed in pathological cellular changes, when antibodies are formed that act against the DNA of cells. The original reason lies in immune changes in the vessels, as a result of which vasculitis develops in systems and organs. These formations can affect not only the skin, but also the synovial membranes, kidneys and other organs.
Immunological vascular lesions in medicine are usually divided into three categories:
passive agglutination;
changes in blood vessels due to immune complexes;
formation of autoantibodies.
In the first case, agglutination is provoked by antibodies interacting with antigens located in the damaged organ.
The second category implies vascular damage when immunocomplex antibodies penetrate into the vessels and provoke an inflammatory process in them.
The third category of vascular lesions is the formation of autoantibodies in vascular membrane tissues.
There are also several mechanisms that can destroy cells, usually this pattern is observed in an autoimmune cytotoxic phenomenon. In some cases, the cells begin to move away from the bloodstream, resulting in thrombocytopenia and leukopenia. With passive agglutination, blood cells are first filled with antigen, after which they are combined with antibodies. If we talk about the counteraction of autoantibodies to platelets and erythrocytes, then not all autoantibodies are pathogenetic.
The occurrence of lupus erythematosus, the causes of which may be different, is closely related to the sensitivity of the human body to a variety of factors, primarily allergenic and infectious. A person may have an allergic reaction to exposure to sunlight, to any infectious foci, low temperature, etc. There is a pronounced genetic predisposition to this disease, but it manifests itself unevenly in the dominant type. For example, there is medicinal lupus erythematosus, which manifests itself after a person has taken certain medications. In addition, the disease can occur under the influence of disorders of the endocrine system, as well as stressful situations. Sulfonamide foci, chronic diseases also complicate the course of this disease. And as for functional neuroendocrine disorders, they can change the level of estrogens and androgens, which also leads to the development of lupus erythematosus and adrenal atrophy. By the way, estrogenic saturation is closely related to the sensitization of lupus erythematosus and allergic reactions. It is for this reason that the disease most often manifests itself in women of childbearing age, the whole point is estrogenic disorders. If we talk about cases of lupus erythematosus in men, statistics show that only one male representative accounts for 8-9 sick women.
Antibodies, accumulating in cells in large quantities, begin to provoke pathological changes in immune complexes, directing them to fight proteins. That is why lupus erythematosus is deservedly attributed to immunopathological diseases.
In the middle of the 20th century, researchers identified nucleophagoditosis, located in the bone marrow of people suffering from this disease. An aggressive type of protein, the anti—nuclear factor, was also detected. This formation acts as an antibody against cellular nucleoproteins and occurs in patients with the form of systemic lupus erythematosus. With discoid lupus erythematosus, the presence of an anti-nuclear factor is observed much less frequently. Relative cellular pathognomonicity can also be noted, since it occurs in patients with other diseases.
It is worth taking a closer look at the two main groups of lupus erythematosus: systemic and discoid forms.
It is known that systemic lupus erythematosus refers to autoimmune diseases. The body produces extraneous proteins that destroy its own cells and tissues. A typical feature of autoimmune diseases in general is the absence of their own tissues as such and their representation by the body as foreign. Subsequently, all this has a completely logical ending: inflammatory processes and tissue destruction. Thus, with lupus erythematosus, not only the mouth and mucous membrane can become inflamed, but also joints, muscles, and so on.
With systemic lupus erythematosus, the clinical picture manifests itself in the form of muscle pain, fever, may be accompanied by polyarthritis, anemia, endocarditis, etc. Systemic lupus erythematosus can also have several forms, and specialists can diagnose them depending on what pathology is observed.
In more than 60% of patients with a systemic form of the disease, the state of the mucosa changes. Sometimes this process is accompanied by edema and even local atrophy. Such skin lesions are the most common and early signs.
As for discoid lupus erythematosus, its diagnosis also depends on clinical manifestations. In this form of the disease, the oral mucosa suffers less often, and the main damage concerns the red lip border. Signs of skin lesions include atrophy and hyperkeratosis, and the process develops in phases. First, spots appear on the skin of the face, increasing in size, and these rashes, localized on the nose and cheeks, gradually take on a butterfly-like shape. In the second phase, the lesions infiltrate, they are replaced by a scaly plaque. The third phase of the disease is atrophy of damaged tissues in the middle of the plaque. The form of the formation has a pronounced hyperkeratosis and is tightly connected to intact tissues. The focus of hyperkeratosis in such cases may resemble flames in outline, it migrates to new areas of the skin.
The second type of discoid lupus erythematosus is chronic lupus. Its complexity lies in the fact that in this form lupus erythematosus can last for many years, while in the warm season the disease worsens.
In addition, there is an erosive form of discoid lupus erythematosus, in which ulcers on the lip border can transform into malignant tumors, provoking a precancerous condition. This form represents epithelial lesions, as well as inflammation and swelling.
Discoid lupus erythematosus does not exclude lesions of the oral mucosa. This is expressed in the appearance of plaques, in the center of which erosive damage is observed.
Symptoms of lupus erythematosus
Depending on the form, as is known, the clinical picture of lupus erythematosus may vary. However, with this disease there are common symptoms: enlarged lymph nodes, hair loss, fever, swelling of the eyes and legs.
The occurrence and development of lupus erythematosus in the body can be recognized by some other symptoms, namely:
chronic fatigue syndrome;
exacerbation of allergic reactions to sunlight;
skin color change;
rashes on the skin of the face;
pain in muscles and joints, their swelling;
Raynaud’s syndrome (sudden whiteness of the toes and hands);
the occurrence of chest pain with deep breaths.
Since lupus erythematosus is a systemic disease, its additional symptoms may manifest in different ways in different people. Some patients feel cramps and headaches, someone falls into depression, and someone suffers from a general lesion of the circulatory and hematopoietic systems.
Lupus erythematosus has a detrimental effect on various organs, sometimes there is inflammation in the kidneys. The process, being a consequence of lupus, is diagnosed as lupus nephritis. Cases of damage to the nervous system and brain, lung inflammation have been noted, and the risk of sudden thrombosis and other pathologies also increases.
Diagnosis of lupus erythematosus
If lesions are present on the skin, then specialists can easily diagnose lupus erythematosus. However, diagnosis may be difficult in the case of isolated spot lesions, for example, only on the red border of the lips or on the mucous membrane. It is for this reason that it is necessary to conduct a complete examination of the body and resort to auxiliary clinical studies: histological, immunomorphological and luminescent.
During the diagnosis, a Wood lamp is used, the rays of which are directed to the hyperkeratosis zones on the lip border, the affected areas will glow bluish-white. If these rays are directed at the mucous membrane, then it will begin to glow with white highlights.
When diagnosing, it is necessary to separate chronic lupus erythematosus from other diseases that are similar in appearance: leukoplakia, lichen planus, etc. If the lesions touch the lip border, then it is necessary to determine that it is lupus erythematosus, and not actinic cheilitis or precancerous Manganotti cheilitis.
As for systemic lupus erythematosus, its diagnosis is carried out after a thorough examination of the internal organs and the detection of disease cells in the bone marrow and in the blood. Patients with lupus erythematosus often suffer from secondary immunodeficiency, which also needs to be taken into account.
Treatment of lupus erythematosus
Treatment of lupus erythematosus should be aimed at the complete destruction of all chronic infections. This should be preceded by the most thorough research. The patient is prescribed quinoline drugs: “Plakvenol” and “Delagil”. Corticosteroids (Dexamethasone and Triamcinolone) are sometimes indicated for treatment, but they should be taken by patients in small doses. In addition, the patient must necessarily take nicotinic and ascorbic acid, vitamins.
Since the treatment of lupus erythematosus should pay attention to strengthening the immune system, many doctors recommend “Decaris”, “Tactivin” and other similar drugs.
As for the manifestations of hyperkeratosis, it needs to be treated by injections prescribed by a specialist. He also determines the necessary dose. The course of therapy includes the use of ointments with corticosteroid properties: “Prednisol”, “Flucinar”, “Lorinden”. They contain antibiotics, and therefore rubbing is successfully used to treat lupus erosions and ulcers.
Agents with antimicrobial characteristics are also shown. With lupus erythematosus, treatment must necessarily take place in a hospital setting, and the course itself is usually quite long.
