Lupus: causes, types of lupus, symptoms, evolution and treatment

Erythematous lupus is an autoimmune disease in the etiology of which genetic, immunological and environmental factors are involved. Genetic predisposition has been demonstrated in numerous research. 70% of cases of lupus erythematosus have a HLA-DRw3 and HLA-DRw2. Numerous familial cases of lupus erythematosus have been reported. Also, immunological anomalies (presence of antibodies) of lupus erythematosus have been revealed in some asymptomatic relatives of patients diagnosed with lupus. Dermatologist Proca Ancuta explains to CSID why this condition can occur and how it can be controlled.

Factors that hurry the disease Imbalance in the immune system plays a major role in triggering the disease, as demonstrated by the occurrence of antibodies. Other factors that may be involved in exacerbating or exacerbating this condition are: smoking, sun exposure, infectious agents, hormones, contraceptives, drugs such as hydralazine, isoniazid, hidantoin, griseofulvin, penicillin, alfametidopa. Types of lupus erythematosus lupus is classified as: chronic lupus erythematosus (cutaneous) lupus erythematosus subacute systemic lupus erythematosus Chronic lupus erythematosus Chronic lupus erythematosus is a form of lupus in which the patient presents only skin lesions, has chronic progression and good prognosis. The lesions can only be located at the facial level or can be generalized. Generally, onset occurs in adulthood (30-40 years).

Usually the disease is asymptomatic, seldom patients accuse pruritus or local pain. Skin lesions appear in the form of telangiectasic erythematous plaques, well delimited, covered by adherent sutures. They present on the internal surface, from the skin, keratoses extensions corresponding to follicular holes ( At the center of the lesions, scarring atrophy occurs over time. 5% of patients have mucosal damage (hyperkeratosis), erythema and pigmented scars in the lips, erythematous or whitish, ulcerative, mouth, tongue and palate. 1-5% of patients with cutaneous lupus erythematosus may develop to systemic lupus erythematosus.

50% of cases evolve to full remission. In the case of generalized lesions, remissions are rarer. After the lesion evolution, chronic erythematous lupus is presented in two forms: Fixed chronic leu (discoid) - Well-defined lesions with erythema, sputum and scarring atrophy, which remain the same months or even years. Chronic centrifugal lesions, predominantly erythematous, which predominantly locate the face on both cheeks, and give the typical butterfly shape (vespertilio). Treatment for chronic lupus erythematosus (cutaneous) The treatment consists of the application of a topical dermatocorticoid or calcineurin inhibitor (tacrolimus, pimecrolimus).

Corticoid injections can be administered for superficial injuries. In systemic therapy, antimalarials (chloroquine, hydroxychloroquine) may be chosen to monitor possible ocular effects. An ophthalmic control should be performed at initiation of treatment and for a period of 6 months). Retinoids (acitretin in case of hyperkeratosis lesions), general corticosteroid therapy (especially when there is resistance to antimalarials) or thalidomide. In the sunny period, due to increased photosensitivity, patients should avoid direct sunlight, use high protection creams and broad-brimmed hats.

A beta-carotene supplement (75-250 mg / day) may also be given for its anti-actin effect. Subacute erythematous lupus erythematous erythematosus represents approximately 20% of cases of LE and predominantly affects women. Skin lesions are symmetrical, spread on the face, upper limbs, neckline, thorax (back) and scalp (scalp). Especially areas exposed to sunlight are affected. Also, in some cases, the patients may also have non-scattered diffuse alopecia, Raynaud's syndrome and periunghial telangiectasis.

Some patients also have kidney or musculoskeletal damage (myalgia - muscle pain, polyarthralgia - joint pain). Cutaneous lesions of subacute erythematous lupus can be of two types: psoriasiform papular-squamous lesions, net defined, with fine scuame, and ring injuries. After healing there remains a slight non-scattering and hypopigmentation atrophy. The treatment is similar to that of chronic erythematous lupus. Patients should be monitored due to the risk of passing to the systemic form of the disease.

Systemic lupus erythematosus Systemic lupus erythematosus is a severe multisystemic disease with multiple clinical manifestations: fever in 90% of cases, skin lesions in 85% of cases, central nervous system disorders with seizures or organic brain damage, psychosis, chronic fatigue . Skin lesions are a typical buttock-like eruption that is localized on the face, but there may also be erythematous papular lesions, urticaria, erythematosus plaques or discoid plaques, as well as chronically erythematous lupus, palmar erythema, peri-angular telangiectasis, . Patients may also have non-scattered diffuse alopecia or painless oral and nasopharyngeal ulcer. These patients require many investigations, which are necessary for assessing the degree of systemic impairment and prognosis assessment. This depends primarily on the severity of kidney damage.

As a general measure, it is necessary to rest and avoid exposure to the sun. Treatment in systemic lupus erythematosus Treatment consists of high-dose general corticosteroid therapy or other immunosuppressants such as azathioprine, mycophenolate mofetil, methotrexate, cyclophosphamide or chlorambucil. Antimalarials are recommended in lighter forms with moderate systemic touch. New therapies (efalizumab, rituximab, leflunomide, belimumab) have been attempted in recent years, but these are still under evaluation. .