Generic selectors
Exact matches only
Search in title
Search in content
Post Type Selectors
Search in posts
Search in pages
Filter by Categories
15th National Conference of the IAOMFP, Chennai, 2006
Abstract
Abstracts from current literature
Acne in India: Guidelines for management - IAA Consensus Document
Addendum
Announcement
Art & Psychiatry
Article
Articles
Association Activities
Association Notes
Award Article
Book Review
Brief Report
Case Analysis
Case Letter
Case Letters
Case Notes
Case Report
Case Reports
Clinical and Laboratory Investigations
Clinical Article
Clinical Studies
Clinical Study
Commentary
Conference Oration
Conference Summary
Continuing Medical Education
Correspondence
Corrigendum
Cosmetic Dermatology
Cosmetology
Current Best Evidence
Current Issue
Current View
Derma Quest
Dermato Surgery
Dermatopathology
Dermatosurgery Specials
Dispensing Pearl
Do you know?
Drug Dialogues
e-IJDVL
Editor Speaks
Editorial
Editorial Remarks
Editorial Report
Editorial Report - 2007
Editorial report for 2004-2005
Errata
Erratum
Focus
Fourth All India Conference Programme
From Our Book Shelf
From the Desk of Chief Editor
General
Get Set for Net
Get set for the net
Guest Article
Guest Editorial
History
How I Manage?
IADVL Announcement
IADVL Announcements
IJDVL Awards
IJDVL AWARDS 2015
IJDVL Awards 2018
IJDVL Awards 2019
IJDVL Awards 2020
IJDVL International Awards 2018
Images in Clinical Practice
Images in Dermatology
In Memorium
Inaugural Address
Index
Knowledge From World Contemporaries
Leprosy Section
Letter in Response to Previous Publication
Letter to Editor
Letter to the Editor
Letter to the Editor - Case Letter
Letter to the Editor - Letter in Response to Published Article
LETTER TO THE EDITOR - LETTERS IN RESPONSE TO PUBLISHED ARTICLES
Letter to the Editor - Observation Letter
Letter to the Editor - Study Letter
Letter to the Editor - Therapy Letter
Letter to the Editor: Articles in Response to Previously Published Articles
Letters in Response to Previous Publication
Letters to the Editor
Letters to the Editor - Letter in Response to Previously Published Articles
Letters to the Editor: Case Letters
Letters to the Editor: Letters in Response to Previously Published Articles
Media and news
Medicolegal Window
Messages
Miscellaneous Letter
Musings
Net Case
Net case report
Net Image
Net Images
Net Letter
Net Quiz
Net Study
New Preparations
News
News & Views
Obituary
Observation Letter
Observation Letters
Oration
Original Article
ORIGINAL CONTRIBUTION
Original Contributions
Pattern of Skin Diseases
Pearls
Pediatric Dermatology
Pediatric Rounds
Perspective
Presedential Address
Presidential Address
Presidents Remarks
Quiz
Recommendations
Regret
Report
Report of chief editor
Report of Hon : Treasurer IADVL
Report of Hon. General Secretary IADVL
Research Methdology
Research Methodology
Resident page
Resident's Page
Resident’s Page
Residents' Corner
Residents' Corner
Residents' Page
Retraction
Review
Review Article
Review Articles
Reviewers 2022
Revision Corner
Self Assessment Programme
SEMINAR
Seminar: Chronic Arsenicosis in India
Seminar: HIV Infection
Short Communication
Short Communications
Short Report
Snippets
Special Article
Specialty Interface
Studies
Study Letter
Study Letters
Supplement-Photoprotection
Supplement-Psoriasis
Symposium - Contact Dermatitis
Symposium - Lasers
Symposium - Pediatric Dermatoses
Symposium - Psoriasis
Symposium - Vesicobullous Disorders
SYMPOSIUM - VITILIGO
Symposium Aesthetic Surgery
Symposium Dermatopathology
Symposium-Hair Disorders
Symposium-Nails Part I
Symposium-Nails-Part II
Systematic Review and Meta-Analysis
Systematic Reviews and Meta-analyses
Systematic Reviews and Meta-analysis
Tables
Technology
Therapeutic Guideline-IADVL
Therapeutic Guidelines
Therapeutic Guidelines - IADVL
Therapeutics
Therapy
Therapy Letter
Therapy Letters
View Point
Viewpoint
What’s new in Dermatology
Generic selectors
Exact matches only
Search in title
Search in content
Post Type Selectors
Search in posts
Search in pages
Filter by Categories
15th National Conference of the IAOMFP, Chennai, 2006
Abstract
Abstracts from current literature
Acne in India: Guidelines for management - IAA Consensus Document
Addendum
Announcement
Art & Psychiatry
Article
Articles
Association Activities
Association Notes
Award Article
Book Review
Brief Report
Case Analysis
Case Letter
Case Letters
Case Notes
Case Report
Case Reports
Clinical and Laboratory Investigations
Clinical Article
Clinical Studies
Clinical Study
Commentary
Conference Oration
Conference Summary
Continuing Medical Education
Correspondence
Corrigendum
Cosmetic Dermatology
Cosmetology
Current Best Evidence
Current Issue
Current View
Derma Quest
Dermato Surgery
Dermatopathology
Dermatosurgery Specials
Dispensing Pearl
Do you know?
Drug Dialogues
e-IJDVL
Editor Speaks
Editorial
Editorial Remarks
Editorial Report
Editorial Report - 2007
Editorial report for 2004-2005
Errata
Erratum
Focus
Fourth All India Conference Programme
From Our Book Shelf
From the Desk of Chief Editor
General
Get Set for Net
Get set for the net
Guest Article
Guest Editorial
History
How I Manage?
IADVL Announcement
IADVL Announcements
IJDVL Awards
IJDVL AWARDS 2015
IJDVL Awards 2018
IJDVL Awards 2019
IJDVL Awards 2020
IJDVL International Awards 2018
Images in Clinical Practice
Images in Dermatology
In Memorium
Inaugural Address
Index
Knowledge From World Contemporaries
Leprosy Section
Letter in Response to Previous Publication
Letter to Editor
Letter to the Editor
Letter to the Editor - Case Letter
Letter to the Editor - Letter in Response to Published Article
LETTER TO THE EDITOR - LETTERS IN RESPONSE TO PUBLISHED ARTICLES
Letter to the Editor - Observation Letter
Letter to the Editor - Study Letter
Letter to the Editor - Therapy Letter
Letter to the Editor: Articles in Response to Previously Published Articles
Letters in Response to Previous Publication
Letters to the Editor
Letters to the Editor - Letter in Response to Previously Published Articles
Letters to the Editor: Case Letters
Letters to the Editor: Letters in Response to Previously Published Articles
Media and news
Medicolegal Window
Messages
Miscellaneous Letter
Musings
Net Case
Net case report
Net Image
Net Images
Net Letter
Net Quiz
Net Study
New Preparations
News
News & Views
Obituary
Observation Letter
Observation Letters
Oration
Original Article
ORIGINAL CONTRIBUTION
Original Contributions
Pattern of Skin Diseases
Pearls
Pediatric Dermatology
Pediatric Rounds
Perspective
Presedential Address
Presidential Address
Presidents Remarks
Quiz
Recommendations
Regret
Report
Report of chief editor
Report of Hon : Treasurer IADVL
Report of Hon. General Secretary IADVL
Research Methdology
Research Methodology
Resident page
Resident's Page
Resident’s Page
Residents' Corner
Residents' Corner
Residents' Page
Retraction
Review
Review Article
Review Articles
Reviewers 2022
Revision Corner
Self Assessment Programme
SEMINAR
Seminar: Chronic Arsenicosis in India
Seminar: HIV Infection
Short Communication
Short Communications
Short Report
Snippets
Special Article
Specialty Interface
Studies
Study Letter
Study Letters
Supplement-Photoprotection
Supplement-Psoriasis
Symposium - Contact Dermatitis
Symposium - Lasers
Symposium - Pediatric Dermatoses
Symposium - Psoriasis
Symposium - Vesicobullous Disorders
SYMPOSIUM - VITILIGO
Symposium Aesthetic Surgery
Symposium Dermatopathology
Symposium-Hair Disorders
Symposium-Nails Part I
Symposium-Nails-Part II
Systematic Review and Meta-Analysis
Systematic Reviews and Meta-analyses
Systematic Reviews and Meta-analysis
Tables
Technology
Therapeutic Guideline-IADVL
Therapeutic Guidelines
Therapeutic Guidelines - IADVL
Therapeutics
Therapy
Therapy Letter
Therapy Letters
View Point
Viewpoint
What’s new in Dermatology
View/Download PDF

Translate this page into:

Net Letter
87 (
1
); 146-146
doi:
10.25259/IJDVL_678_18

Ultrasonography for assessing the disease activity of sclerodermoid lupus erythematosus panniculitis

Department of Dermatology, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan

Corresponding author: Prof. Sindy Hu, Chang Gung Memorial Hospital, 199, Tun-Hwa North Road, Taipei 105, Taiwan. E-mail: sindyhu@hotmail.com

Licence
This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.

How to cite this article: Cheng CY, Huang YL, Lee MC, Hu S. Ultrasonography for assessing the disease activity of sclerodermoid lupus erythematosus panniculitis. Indian J Dermatol Venereol Leprol 2021;87:146-146.

Sir,

Lupus erythematosus panniculitis is an uncommon cutaneous manifestation of lupus erythematosus. The coexistence of lupus erythematosus panniculitis and localized scleroderma is an extremely rare manifestation. Herein, we report a case of sclerodermoid lupus erythematosus panniculitis in which ultrasonography was used to monitor the therapeutic response.

A 43-year-old woman presented to our clinic with tender thickened skin lesion on the right thigh of 10 months duration. Physical examination revealed a brownish indurated plaque with peripheral erythema and epidermal atrophy on the posterolateral aspect of her right thigh [Figure 1a]. She also had malar rash [Figure 1b]. Ultrasonography (Acuson X150TM, Siemens Medical Solution USA, Mountain View, CA) demonstrated thickening of dermis and subcutaneous layer (4.4 mm and 16.3 mm, respectively). The subcutis was homogenously hyperechoic with cloudy appearance [Figure 1c]. The color Doppler also revealed increased blood flow [Figure 1d].

Brownish indurated plaque with peripheral erythema on the posterolateral aspect of the right thigh
Figure 1a:
Brownish indurated plaque with peripheral erythema on the posterolateral aspect of the right thigh
Malar rash was noted on bilateral cheeks
Figure 1b:
Malar rash was noted on bilateral cheeks
Ultrasonographic image showing thickened dermis and subcutaneous layer, and homogenously hyperechoic subcutis with a cloudy appearance. The thickness of the dermis and the subcutaneous layer was 4.4 mm (solid double arrow line) and 16.3 mm (dotted double arrow line), respectively
Figure 1c:
Ultrasonographic image showing thickened dermis and subcutaneous layer, and homogenously hyperechoic subcutis with a cloudy appearance. The thickness of the dermis and the subcutaneous layer was 4.4 mm (solid double arrow line) and 16.3 mm (dotted double arrow line), respectively
Increased blood flow was noted in color Doppler examination
Figure 1d:
Increased blood flow was noted in color Doppler examination

The thickness of dermis and subcutis of the contralateral nonlesional area on her left thigh was 1.0 mm and 13.0 mm, respectively [Figure 1e]. A skin biopsy taken from the plaque on her right thigh showed hyperkeratosis, mild acanthosis, melanin incontinence, thickened basement membrane and dense compact sclerosis of the dermis and subcutaneous layer with lymphocytic infiltration of vessels, sweat glands and fat lobules [Figures 2a-c]. Lupus band test was positive [Figure 2d]. The diagnosis of sclerodermoid lupus panniculitis was made based on the clinicopathological findings.

The thickness of the dermis and subcutaneous layer of the contralateral non-lesional area was 1.0 mm (solid double arrow line) and 13.0 mm (dotted double arrow line), respectively
Figure 1e:
The thickness of the dermis and subcutaneous layer of the contralateral non-lesional area was 1.0 mm (solid double arrow line) and 13.0 mm (dotted double arrow line), respectively
The histopathology showing melanin incontinence, dense compact sclerosis of the dermis, periadnexal and perivascular lymphocytic infiltration (H and E, ×100)
Figure 2a:
The histopathology showing melanin incontinence, dense compact sclerosis of the dermis, periadnexal and perivascular lymphocytic infiltration (H and E, ×100)
Marked septal fibrosis with lymphocytic infiltration in subcutaneous tissue (H and E, ×100)
Figure 2b:
Marked septal fibrosis with lymphocytic infiltration in subcutaneous tissue (H and E, ×100)
Melanin incontinence and thickened basement membrane. (H and E, ×400)
Figure 2c:
Melanin incontinence and thickened basement membrane. (H and E, ×400)
Lupus band test showing granular deposition of IgG at the dermo-epidermal junction
Figure 2d:
Lupus band test showing granular deposition of IgG at the dermo-epidermal junction

Laboratory investigation showed leukocytopenia (2.7X103/uL), low complement levels (C3 and C4 25.2 and 2.62 mg/dL, respectively) as well as positive Anti Nuclear Antibody (speckled type: 1:1280), anti-sm (298AU/mL) and anti-dsDNA (203.3 WHO units). The diagnosis of systemic lupus erythematosus was made according to the 2012 systemic lupus international collaborating clinics SLE Criteria. The patient then received oral prednisolone 60 mg and hydroxychloroquine 400 mg daily along with application of clobetasol ointment twice a day.

There was slight improvement in erythema after treatment for 2 months [Figure 3a]. Ultrasonography of dermis and subcutis of the affected area showed a reduction in their thickness and the echogenicity of subcutis was also decreased [Figure 3b]. No increase in blood flow was detected [Figure 3c]. The ultrasonographic picture of the contralateral non-lesional area is demonstrated in Figure 3d. After 6 months of treatment, the lesions improved leaving behind post-inflammatory hyperpigmentation [Figure 4a]. The body weight of the patient also increased from 65 to 70 kg. Follow up imaging revealed reduced thickness of dermis and subcutis (1.0 mm and 15.0 mm, respectively) and the echogenicity of the subcutis returned to clear septate fat lobules [Figure 4b]. Color Doppler examination showed no increase in the blood flow [Figure 4c]. The thickness of dermis and subcutis in the ultrasonography of the contralateral non-lesional area was 1.1 mm and 15.3 mm, respectively [Figure 4d] Application of clobetasol ointment was discontinued but oral prednisolone and hydroxychloroquine were continued for the systemic involvement.

The erythema of skin lesions improved slightly after treatment for 2 months
Figure 3a:
The erythema of skin lesions improved slightly after treatment for 2 months
The thickness of dermis and subcutis were reduced to 1.8 mm (solid double arrow line) and 15.6 mm (dotted double arrow line), respectively, and the echogenicity was also reduced
Figure 3b:
The thickness of dermis and subcutis were reduced to 1.8 mm (solid double arrow line) and 15.6 mm (dotted double arrow line), respectively, and the echogenicity was also reduced
No increased blood flow was detected in the color Doppler examination
Figure 3c:
No increased blood flow was detected in the color Doppler examination
The thickness of the dermis and subcutaneous layer of the contralateral non-lesional area was 1.1 mm (solid double arrow line) and 12.8 mm (dotted double arrow line), respectively
Figure 3d:
The thickness of the dermis and subcutaneous layer of the contralateral non-lesional area was 1.1 mm (solid double arrow line) and 12.8 mm (dotted double arrow line), respectively
After 6 months of treatment, the skin lesions improved with post- inflammatory hyperpigmentation name and initials will not be published and due efforts will be made to conceal the identity but anonymity cannot be guaranteed.
Figure 4a:
After 6 months of treatment, the skin lesions improved with post- inflammatory hyperpigmentation name and initials will not be published and due efforts will be made to conceal the identity but anonymity cannot be guaranteed.
The thickness of dermis and subcutis were reduced to 1.0 mm (solid double arrow line) and 15.0 mm (dotted double arrow line), respectively, and the echogenicity returned to clear septate fat lobules
Figure 4b:
The thickness of dermis and subcutis were reduced to 1.0 mm (solid double arrow line) and 15.0 mm (dotted double arrow line), respectively, and the echogenicity returned to clear septate fat lobules
No increase in blood flow after treatment in color Doppler examination
Figure 4c:
No increase in blood flow after treatment in color Doppler examination
The thickness of the dermis and subcutaneous layer of the contralateral non-lesional area was 1.1 mm (solid double arrow line) and 15.3 mm (dotted double arrow line), respectively
Figure 4d:
The thickness of the dermis and subcutaneous layer of the contralateral non-lesional area was 1.1 mm (solid double arrow line) and 15.3 mm (dotted double arrow line), respectively

The clinical and histopathological coexistence of lupus erythematosus panniculitis and localized scleroderma was first described by Umbert and Winkelmann in 1978.1 According to previous studies, type I interferon and interferon-gamma inducible protein-10 play important roles in the inflammatory and fibrotic processes of both cutaneous lupus erythematosus and scleroderma.2 Therefore, the two diseases may have a common dysfunction of the immunological pathway. In addition, some authors also suggest that the lichenoid reaction of cutaneous lupus erythematosus may provoke the fibroblast-dependent reparative dysfunction and cause a sclerosing reaction.3

In a review patients with sclerodermoid lupus erythematosus panniculitis, the linear distribution of cutaneous lesions along the Blaschko’s line was found to be a common feature and this may be related to genetic mosaicism.3 Although the skin lesion in our patient is not in a typical linear pattern, the cutaneous distribution along Blaschko’s line may be regarded as a broadband variant mosaicism.

During recent years, ultrasonography has emerged as a new diagnostic imaging technique in dermatology and can be used to assess the activity of many someskin diseases. According to the previous literature, the ultrasonography of active morphea lesions revealed increase in the thickness of dermis and cutaneous blood flow.4 On the other hand, lobular panniculitis in ultrasonography revealed a diffuse increase in the echogenicity of the fatty lobules with increased hypodermal vascularity.5 In our patient we could find a correlation between the histopathological and ultrasonographic findings. The improvement noted in the ultrasonographic finding after treatment correlated with the clinical improvement in induration and tenderness. The clinical improvement in erythema was associated with the decreased vascularity noted in color Doppler. Besides, we also found that before treatment, the thickness of subcutis in the lesional area was more than the contralateral non-lesional area but there was no significant difference after treatment. However, the value of subcutaneous thickness in monitoring the activity of disease may be limited due to the effect of change in the body weight.

In summary, we report a rare case of sclerodermoid lupus erythematosus panniculitis and its ultrasonographic findings before and after treatment. Ultrasonography may be a useful noninvasive tool for monitoring therapeutic response and for modifying treatment in such patients.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given her consent for her images and other clinical information to be reported in the journal. The patient understands that

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

  1. , . Concurrent localized scleroderma and discoid lupus erythematosusCutaneous 'mixed' or 'overlap' syndrome. Arch Dermatol. 1978;114:1473-8.
    [CrossRef] [PubMed] [Google Scholar]
  2. , , . Type I interferon-mediated autoimmune diseases: Pathogenesis, diagnosis and targeted therapy. Rheumatology (Oxford). 2017;56:1662-75.
    [CrossRef] [PubMed] [Google Scholar]
  3. , , , , , . Sclerodermiform linear lupus erythematosus: A distinct entity or coexistence of two autoimmune diseases? J Am Acad Dermatol. 2008;58:665-7.
    [CrossRef] [PubMed] [Google Scholar]
  4. , , , . Activity assessment in morphea using color Doppler ultrasound. J Am Acad Dermatol. 2011;65:942-8.
    [CrossRef] [PubMed] [Google Scholar]
  5. . Sonography of dermatologic emergencies. J Ultrasound Med. 2017;36:1905-14.
    [CrossRef] [PubMed] [Google Scholar]

Fulltext Views
4,748

PDF downloads
4,477
View/Download PDF
Download Citations
BibTeX
RIS
Show Sections