15. My daughter has DLE and Tumid Lupus. It started with a lesion on her arm and over the last 3 years has spread to her face, chest, and back. She recently discovered lesions on her fingers. Can you please provide information on Tumid Lupus and its treatment? Given her progression, where can she expect to see lesions next? San Diego, CA Tumid lupus is the newest type of skin lupus that has been described (really in the past 10-15 years). It is still controversial among some investigators if this is truly a form of lupus, although I believe that it should be considered just that. Tumid (meaning swollen or protuberant) lupus lesions are different in that they are edematous (puffy) lesions of the skin. The inflammation involves the dermis (the thick connective tissue part of the skin), whereas many forms of skin lupus affect the epidermis (the most superficial, thin layer). Tumid lupus is really a descriptive term for the skin lesions, although it must be supported by certain pathologic findings on skin biopsy. We do not understand exactly how or if this form of lupus differs from other more familiar types of lupus, in terms of cause. Tumid lupus spots can be difficult to treat, but they do not leave scarring when they resolve. They are said to be amongst the most sun sensitive forms of lupus, so sun protection for your daughter is of high importance. Most patients with tumid lupus lesions on the skin actually do not have systemic lupus, nor do they seem to have a high chance of progressing to systemic lupus. Tumid lupus lesions typically occur in sun-exposed areas (face, chest, back, arms), and so I would not necessarily expect that your daughter would continue to have progressive tumid lesions in other areas of her body. The lesions on the fingers may indeed be other types of skin lupus (either discoid lupus or even possibly a condition called chilblain’s lupus). In general, tumid lupus is treated much the same way as other skin forms of lupus. We start with topical corticosteroids if there are only few lesions, and then use antimalarial treatment (e.g. Plaquenil), possibly in combination, if the lesions are more widespread or resistant to topical therapies. If that is not effective, then we tend to move to more typical medications like methotrexate, CellCept, or Imuran. Prednisone is generally quite effective for tumid lupus, but it is not an acceptable long term therapy due to side effects.
Posted on: Mon, 10 Nov 2014 00:26:39 +0000
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