Chronic Cutaneous Lupus

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What are the symptoms of cutaneous lupus?
The symptoms of cutaneous lupus may include a variety of different looking skin rashes, photosensitivity (where exposure to ultra-violet light triggers a rash), and sometimes ulcers on the inside of the nose or mouth.


What do the rashes look like?
There are a variety of ways that cutaneous lupus rashes can appear. The distinctive rash is called the "butterfly rash," which is a rash that extends across the cheeks of the face and the bridge of the nose. It can be flat or raised; it can be bright red or it can be just a mild blushing, light pink coloration to the skin. It appears on the face in a pattern that looks like a butterfly; the wings are beneath both eyes and the body of the butterfly covers the bridge of the nose.

Another classic rash found in cutaneous lupus is the discoid rash. This rash is coin-shaped or oval in shape, like a disk and it is seen on areas of the skin that are exposed to sunlight. Discoid lesions (sores) tend to be red and raised and become scaly. When they heal they can leave behind a scar. These rashes can also result in a change in coloring of the skin, making the area around the lesion either lighter or darker in color. These discoid lesions may appear on the scalp; on the face in a butterfly distribution; or, as mentioned earlier, in areas where the skin receives sun exposure, especially, for example, the V of the neck. Discoid lupus erythematosus (LE) lesions are usually painless and typically do not itch.


Chronic cutaneous lupus may also appear in different forms including:

verrucous (wart-like) discoid LE
lupus tumidus - elevated areas of red skin with no scale or scarring
lupus profundus - discoid skin lesions in conjunction with panniculitis
palmar-plantar erosive discoid LE - discoid lesions on the hands and feet
Another type of lupus skin rash is classified as the subacute cutaneous lesions. These are lesions characterized by redness. They are also coin-shaped, very photosensitive and they get worse when exposed to ultra-violet light. These are lesions that do not leave behind scars, and can appear over large areas of the body. People who have subacute cutaneous lupus erythematosus (SCLE-a subset of cutaneous lupus) may experience systemic symptoms such as:
Muscle and joint pain, fever and general discomfort.
Serious kidney or nervous system problems are rare.
These are just a few examples of what cutaneous lupus rashes may look like. Because the appearance of skin rashes in lupus can be quite variable, it can be difficult to diagnose just by looking at the lesion, and therefore other tests may be necessary.


How is cutaneous lupus diagnosed?
Cutaneous lupus, because of the great deal of variability in the way that the skin rashes may appear, can be quite difficult to diagnose. However, a skin biopsy may be performed and this may be diagnostic.

What kind of Doctor specializes in cutaneous lupus?
A dermatologist specializes in diseases of the skin, hair and nails. Cutaneous lupus is one of hundreds of diseases that involve these areas.

How is cutaneous lupus treated?
Treatment of cutaneous lupus may include corticosteroid creams or ointments applied to the rash or lesions. If the lesion does not respond to cream or ointment, the doctor may prescribe injections of corticosteroids directly into the lesion. If a person has particularly widespread lesions, oral corticosteroid medications may be prescribed or the doctor may prescribe anti-malarial medications such as Plaquenil (hydroxychloroquine).

In addition to these medications, sunscreens are an important part of the prevention of photosensitivity (where skin exposed to ultra-violet light reacts by developing a rash) reactions that may occur with cutaneous lupus lesions.

 How is cutaneous lupus different from systemic lupus?
Cutaneous lupus is confined to the skin, whereas systemic lupus may involve not only the skin but any of the other organ systems in the body.

Can cutaneous lupus turn into systemic lupus?
In approximately 10% of the cases of cutaneous lupus, it evolves and develops into systemic lupus. However, this can't be predicted or prevented from happening.


I have hair loss due to several scars on my scalp. All are about the size of silver dollars. Is there anything to help this kind of hair loss?
If biopsy results indicate advanced scarring on the scalp, then there is little chance of bringing back significant amounts of hair. If, on the other hand, scarring is not prevalent, then treatment with corticosteroid and/or antimalarial drugs may be successful in getting the hair to return. When the disease is inactive, and scarring is not present hair usually grows back.


Will the drugs used to treat baldness help the hair loss due to lupus?
Suppressing the disease with medication helps hair to re-grow.


Is there anything that can be done to cover the lesions (sores) that show-up on my face?
Yes. There are make-up products available commercially which may be helpful in this situation. Fallene's Total Block® SPF 60 Foundation can be used as a make-up as well as a sun block.
References:
Covermark Cosmetics
157 Veterans Drive, Suite D
Northvale, NJ 07647
1-800-524-1120
www.covermarkusa.com/

Total Block
Fallene, Ltd.
677 West De Kalb Pike
King of Prussia, PA 19406
1-800-332-5536
http://www.totalblock.com/

Lupus Erythematosus
 
  Photosensitivity is a frequent symptom of SLE. In patients with SLE, immunoreactants are deposited at the dermal-epidermal junction of sun-exposed skin. Studies have shown that UV-B-irradiated keratinocytes from patients with SLE manifest increased binding of IgG autoantibodies directed against soluble intracellular antigens, including Sm, RNP, SSA/R, and SSB/La [15]. These findings could help to explain how sun exposure exacerbates SLE in some patients (Figure 7) [16]. It is important to emphasize that photoaggravation occurs most commonly in patients with the subacute variant of SLE. Photoaggravation also can influence the expression of other diseases (Table 9).
 
 Action spectrum studies in patients with SLE indicate that both UV-B and UV-A energy may be involved, either alone or in tandem [17]. Treatment consists of photoprotection, potent topical corticosteroids, and systemic antimalarials
 
 


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Stress Hormone Enables Lupus Antibodies to Alter Behavior, Damage Cognition

Lupus Research Institute (LRI) Funds Initial Findings

New York, NY, January 17, 2006 –- A major breakthrough in lupus research—one that may fundamentally change thinking on how the disease affects behavior and cognition—was reported in the January 17, 2006 Proceedings of the National Academy of Sciences (PNAS). Entitled Immunity and behavior: Antibodies alter emotion, the research builds upon a framework of findings supported by LRI funds from 2001 to 2004.

A number of people with systemic lupus erythematosus (S.L.E.) experience subtle but insidious changes in behavior (affect), such as unusual feelings of fear (or lack of fear) and loss of interest or curiosity. And an estimated 8 in 10 at some point experience progressive cognitive impairment characterized by headache, confusion, fatigue, memory loss, difficulty expressing thoughts, and (occasionally) seizures or strokes.

Aside from actual inflammation in the brain, a grave but relatively uncommon lupus complication, the causes of these behavioral and cognition issues in people with lupus have been elusive. Now answers to the mystery are starting to surface, thanks to the bold and novel research of Betty Diamond, M.D., Chief of the Division of Rheumatology and Professor of Medicine at Columbia University College of Physicians and Surgeons, and lead author of the PNAS study.

The LRI— the leading nonprofit sponsor of research into lupus—awarded Dr. Diamond the Novel Research Grant that enabled her to first explore the channels responsible for brain damage in lupus.

“Our initial grant from LRI allowed us to test our hypothesis,” said Dr. Diamond, “linking lupus antibodies and stress to cognitive impairment. I am convinced that, without Lupus Research Institute funding, our research would not have gotten off the ground.”

Problem Identified, Solution Proposed
With the LRI grant, Dr. Diamond and colleagues made three, core discoveries. Using mice, they concluded that lupus antibodies can destroy nerve cells in the brain, causing serious cognitive impairment. They also found that infection can pave the way for these damaging antibodies to penetrate into the brain, which is normally protected from various antibodies by a “wall” called the blood-brain barrier. Finally, they identified the Alzheimer’s medicine, memantine, as a potential drug model for inhibiting lupus brain damage.

With the PNAS study, Dr. Diamond and colleagues report that the penetration of toxic antibodies into the brain likely leads not just to thinking (cognition) problems, but also to changes in behavior. Specifically, the disease’s anti-DNA antibodies leak not only into the brain and damage neurons in an area called the hippocampus, which houses memories and the ability to navigate (among other things). They can also make their way into the amygdala, a brain region that governs fear and emotional responses, and cause damage there.

The researchers identify the stress hormone, epinephrine, as the agent responsible for letting the lupus antibodies gain access to the amygdala. These antibodies cause damage by binding to neurons and activating a receptor on the surface of the cell. Overstimulation of the receptor can lead to cell death. Epinephrine, which is also known as adrenaline, is produced by the adrenal glands in reaction to stress. Increased levels of the hormone can raise blood flow to the brain and cause leaks in the normally well-sealed barriers to this precious organ.

The PNAS authors identified two potential therapies for protecting the brain. The Alzheimer's drug (memantine) blocks glutamate, and may prevent the death of cells in parts of the brain such as the amygdala. Given this drug’s various undesirable side effects, the authors also propose investigating the therapeutic potential of a small molecule (a peptide) that they identified. The peptide may be able to protect brain cells from the anti-DNA antibodies as well.

LRI: Giving New Ideas Room to Grow
“The LRI’s decision to fund Dr. Diamond’s brilliant research clearly demonstrates its acumen in selecting novel ideas of real merit that ultimately pay off in a very big way,” said William Paul, M.D., Chairman of the LRI Scientific Advisory Board, upon hearing of the new research. Dr. Paul is Chief of the Laboratory of Immunology at the NIH’s National Institute of Allergy and Infectious Diseases.

“The LRI is a catalyst. It brings innovative work to the fore, allowing investigators to make important discoveries that are essential to command greater funding from the NIH and the pharmaceutical industry.”

Adds Margaret G. Dowd, LRI President: “By supporting scientists who are willing to defy conventional thinking, we are helping to change the face of lupus research. The strategy behind the Lupus Research Institute is clearly working, and the more than 1.5 million Americans with the disease will directly benefit.”

About Lupus
Lupus is a chronic autoimmune disease in which the body’s immune system, which normally functions to protect against foreign invaders, becomes hyperactive, forming antibodies that attack normally healthy tissues, including the heart, kidneys, lungs, liver, blood and skin. Complications from lupus can lead to heart attack, stroke and kidney failure.
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Adminஐﻬ:
Lupus Research Institute Announces 2006 Funding Opportunities For New Scientific Approaches To Lupus

Three-Year Grants Aim at Accelerating Novel Research to Unlock the Mysteries of Lupus

The Lupus Research Institute (LRI), sponsor of the nation’s largest innovative, novel research program to prevent, treat and cure lupus, invites applications for financial support for novel research into Systemic Lupus Erythematosus (SLE). Applications for the three year grants, totaling $300,000, are due on June 1, 2006, with funding commencing on November 1, 2006.

The LRI's request for proposals comes at a particularly crucial time in overall funding for research, in light of recent cuts to the National Institute of Health's (NIH) budget for the first time in nearly 40 years, according to Margaret Dowd, LRI President.

The LRI Novel Research Program is designed to encourage high-impact proposals and novel approaches to lupus from investigators who approach lupus research from fresh angles.

"The Lupus Research Institute's Novel Research Program is solely devoted to new science in lupus, based on the premise and proof that out-of-the-box thinking and idea-driven science leads to breakthroughs in basic and clinical lupus research," said Ms. Dowd. "The LRI's 'high-ROI', return-on-investment in terms of research breakthroughs achieved and extended government funding secured, proves the Institute’s strategy is working. The LRI peer review process selects bold, scientifically sound research—new hypotheses in lupus, unimpeded by traditional thinking—which, without our support, would simply not get off the ground."

Since its founding in 2000, the Lupus Research Institute has awarded more than $14.5 million in grants to nearly 60 scientists at leading institutions nationwide. To date, 91 percent of LRI investigators who completed their LRI studies have gone on to secure large-scale federal funding. The LRI's initial investment of nearly $2.5 million in grants yielded $11.2 million in new funding for scientists to expand their LRI studies.

This year's LRI grant announcement follows news that the NIH's budget is to be cut for the first time since 1970. Less NIH funding for research means there will be fewer scientific breakthroughs and advances in disease prevention and treatment. But it also means funding may go to "less risky" studies, thereby jeopardizing novel research, according to Margaret Dowd. "The Lupus Research Institute was created expressly to meet calls for a new scientific culture that allows lupus investigators to test novel hypotheses and, in doing so, to make important discoveries," said Ms. Dowd. "The cuts to the NIH budget point to the need for the private sector to step up to the plate and fill the gap in funding innovative biomedical research."

Grant applications are due on June 1, 2006, with funding commencing on November 1, 2006. For additional information and a copy of the grant application, visit the LRI website—www.lupusresearchinstitute.org—or contact Laura Hack, Grants Administrator, at lhack@lupusny.org or at 212-685-4118.

About Lupus

Lupus is a chronic autoimmune disease in which the body's immune system–normally our natural defense against disease—becomes overactive and forms antibodies that attack and damage vital organs and tissues such as the skin, brain, heart, lungs, blood and kidneys. Lupus afflicts 1.5 million Americans, 90 percent of whom are women. It is a leading cause of kidney disease, stroke and cardiovascular disease in young women.

Lupus is unpredictable, highly individualized, hard to live with–and sometimes fatal. As yet, there is no known cause or cure. No new treatments have been approved for lupus in 40 years.

About the Lupus Research Institute

The LRI is the nation's leading sponsor of novel, innovative lupus research–new science to prevent, treat and cure lupus. For more information, visit www.lupusresearchinstitute.org or contact the LRI: Lupus Research Institute, 149 Madison Avenue, Suite 205, New York, NY 10016, Tel: 212-685-4118; Fax: 212-545-1843; E-mail: lupus@lupusny.org.
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New folder for the Research Information to be transferred into for easier reading

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~What are the symptoms of cutaneous lupus?

The symptoms of cutaneous lupus may include a variety of different looking skin rashes, photosensitivity (where exposure to ultra-violet light triggers a rash), and sometimes ulcers on the inside of the nose or mouth.


~What do the rashes look like?

There are a variety of ways that cutaneous lupus rashes can appear. The distinctive rash is called the "butterfly rash," which is a rash that extends across the cheeks of the face and the bridge of the nose. It can be flat or raised; it can be bright red or it can be just a mild blushing, light pink coloration to the skin. It appears on the face in a pattern that looks like a butterfly; the wings are beneath both eyes and the body of the butterfly covers the bridge of the nose.

Another classic rash found in cutaneous lupus is the discoid rash. This rash is coin-shaped or oval in shape, like a disk and it is seen on areas of the skin that are exposed to sunlight. Discoid lesions (sores) tend to be red and raised and become scaly. When they heal they can leave behind a scar. These rashes can also result in a change in coloring of the skin, making the area around the lesion either lighter or darker in color. These discoid lesions may appear on the scalp; on the face in a butterfly distribution; or, as mentioned earlier, in areas where the skin receives sun exposure, especially, for example, the V of the neck. Discoid lupus erythematosus (LE) lesions are usually painless and typically do not itch.

~Chronic cutaneous lupus may also appear in different forms including:

   1. verrucous (wart-like) discoid LE
   2. lupus tumidus - elevated areas of red skin with no scale or scarring
   3. lupus profundus - discoid skin lesions in conjunction with panniculitis
   4. palmar-plantar erosive discoid LE - discoid lesions on the hands and feet

Another type of lupus skin rash is classified as the subacute cutaneous lesions. These are lesions characterized by redness. They are also coin-shaped, very photosensitive and they get worse when exposed to ultra-violet light. These are lesions that do not leave behind scars, and can appear over large areas of the body. People who have subacute cutaneous lupus erythematosus (SCLE-a subset of cutaneous lupus) may experience systemic symptoms such as:

    * muscle and joint pain,
    * fever and
    * general discomfort.

Serious kidney or nervous system problems are rare.

These are just a few examples of what cutaneous lupus rashes may look like. Because the appearance of skin rashes in lupus can be quite variable, it can be difficult to diagnose just by looking at the lesion, and therefore other tests may be necessary.

~How is cutaneous lupus diagnosed?

Cutaneous lupus, because of the great deal of variability in the way that the skin rashes may appear, can be quite difficult to diagnose. However, a skin biopsy may be performed and this may be diagnostic.

What kind of Doctor specializes in cutaneous lupus?

A dermatologist specializes in diseases of the skin, hair and nails. Cutaneous lupus is one of hundreds of diseases that involve these areas.

~How is cutaneous lupus treated?

Treatment of cutaneous lupus may include corticosteroid creams or ointments applied to the rash or lesions. If the lesion does not respond to cream or ointment, the doctor may prescribe injections of corticosteroids directly into the lesion. If a person has particularly widespread lesions, oral corticosteroid medications may be prescribed or the doctor may prescribe anti-malarial medications such as Plaquenil (hydroxychloroquine).

In addition to these medications, sunscreens are an important part of the prevention of photosensitivity (where skin exposed to ultra-violet light reacts by developing a rash) reactions that may occur with cutaneous lupus lesions.


~ How is cutaneous lupus different from systemic lupus?

Cutaneous lupus is confined to the skin, whereas systemic lupus may involve not only the skin but any of the other organ systems in the body.

Can cutaneous lupus turn into systemic lupus?

In approximately 10% of the cases of cutaneous lupus, it evolves and develops into systemic lupus. However, this can't be predicted or prevented from happening.
(source-Lupus.org)

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