Letters to the Editor
REFERENCES 1 Yokogawa N, Tanikawa A, Amagai M et al. Response to hydrochloroquine in Japanese patients with lupus-related skin disease using the cutaneous lupus erythematosus disease area and severity index (CLASI). Mod Rheumatol 2013; 23: 318–322. 2 Ikeda T, Kanazawa N, Furukawa F. Hydroxychloroquine administration for Japanese lupus erythematosus in Wakayama: a pilot study. J Dermatol 2012; 39: 531–535.
3 Momose Y, Arai S, Eto H, Kishimoto M, Okada M. Experience with the use of hydroxychloroquine for the treatment of lupus erythematosus. J Dermatol 2013; 40: 94–97. 4 Wimmershoff MB, Hohenleutner U, Landthaler M. Discoid lupus erythematosus and lupus profundus in childhood: a report of two cases. Pediatr Dermatol 2003; 20: 140–145.
Amicrobial pustulosis-like rash associated with systemic lupus erythematosus Dear Editor, Amicrobial pustulosis is a relapsing pustulosis that predominantly affects the scalp, cutaneous folds and periorificial regions, and has been reported to be associated with autoimmune disorders. Here, we present a case of systemic lupus erythematosus (SLE) developing an amicrobial pustulosis-like rash. A 45-year-old man presented with multiple infiltrating erythematous plaques with pustulosis on his neck, trunk and limbs. He had a history of SLE of 18 years’ duration. He had no history to start new drugs or to have bacterial and/or viral infections. Physical examination revealed multiple infiltrating erythematous plaques on his face, neck, trunk and limbs and erosions on his back (Fig. 1a). The next day, multiple pustules began to develop rapidly on those plaques including minor folds of external auditory canals and retroauricular flexures (Fig. 1b). Histopathological examination from an erythematous plaque showed hydropic degeneration of the basal cell layer (Fig. 1c), and direct immunofluorescence tests from the same specimen revealed depositions of immunoglobulin (Ig)G, IgA and C3 at the dermoepidermal junction (data not shown). Histopathological examination from a pustule showed small and focal spongiform pustules coalescing to a large pustule in the epidermis and clefts below the epidermis (Fig. 1d). Mucin was deposited in the upper dermis of both an erythematous plaque and a pustule. Laboratory investigations detected an elevated antinuclear antibody titer of 1:160 (normal,
REFERENCES 1 Yokogawa N, Tanikawa A, Amagai M et al. Response to hydrochloroquine in Japanese patients with lupus-related skin disease using the cutaneous lupus erythematosus disease area and severity index (CLASI). Mod Rheumatol 2013; 23: 318–322. 2 Ikeda T, Kanazawa N, Furukawa F. Hydroxychloroquine administration for Japanese lupus erythematosus in Wakayama: a pilot study. J Dermatol 2012; 39: 531–535.
3 Momose Y, Arai S, Eto H, Kishimoto M, Okada M. Experience with the use of hydroxychloroquine for the treatment of lupus erythematosus. J Dermatol 2013; 40: 94–97. 4 Wimmershoff MB, Hohenleutner U, Landthaler M. Discoid lupus erythematosus and lupus profundus in childhood: a report of two cases. Pediatr Dermatol 2003; 20: 140–145.
Amicrobial pustulosis-like rash associated with systemic lupus erythematosus Dear Editor, Amicrobial pustulosis is a relapsing pustulosis that predominantly affects the scalp, cutaneous folds and periorificial regions, and has been reported to be associated with autoimmune disorders. Here, we present a case of systemic lupus erythematosus (SLE) developing an amicrobial pustulosis-like rash. A 45-year-old man presented with multiple infiltrating erythematous plaques with pustulosis on his neck, trunk and limbs. He had a history of SLE of 18 years’ duration. He had no history to start new drugs or to have bacterial and/or viral infections. Physical examination revealed multiple infiltrating erythematous plaques on his face, neck, trunk and limbs and erosions on his back (Fig. 1a). The next day, multiple pustules began to develop rapidly on those plaques including minor folds of external auditory canals and retroauricular flexures (Fig. 1b). Histopathological examination from an erythematous plaque showed hydropic degeneration of the basal cell layer (Fig. 1c), and direct immunofluorescence tests from the same specimen revealed depositions of immunoglobulin (Ig)G, IgA and C3 at the dermoepidermal junction (data not shown). Histopathological examination from a pustule showed small and focal spongiform pustules coalescing to a large pustule in the epidermis and clefts below the epidermis (Fig. 1d). Mucin was deposited in the upper dermis of both an erythematous plaque and a pustule. Laboratory investigations detected an elevated antinuclear antibody titer of 1:160 (normal,
![[Rash on the back revealing systemic lupus erythematosus].](/assets/img/hold.png)
