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Bullous Systemic Lupus Erythematosus: A Review and Update to Diagnosis and Treatment

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Abstract

Bullous systemic lupus erythematosus (BSLE) is a rare cutaneous complication of systemic lupus erythematosus (SLE). It is a heterogeneous disease that is caused by autoantibodies to the dermoepidermal junction, mainly type VII collagen. Similarities in histology and immunopathology exist between BSLE and other primary bullous dermatoses, namely dermatitis herpetiformis (DH) and epidermolysis bullosa acquisita (EBA), respectively. EBA and BSLE commonly share the same autoantibody to type VII collagen and heterogeneous clinical presentations, creating a diagnostic challenge. However, clinical presentation combined with histology, immunological testing, and concomitant diagnosis of SLE distinguish this entity from other similar dermatoses. Diagnosis of this disease is important given its coexistence with SLE and its many complications. New developments in IgG subtyping have shown subtle variations in IgG subtypes between EBA and BSLE. In addition, rituximab was recently found to be efficacious in recalcitrant cases of BSLE that do not respond to dapsone and immunosuppressants. We review the topic of BSLE with emphasis on clinical, histologic, and immunopathologic features, as well as new methods of diagnosis and treatment.

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Acknowledgments

No sources of funding were used to prepare this review. James J. Contestable, Jon H. Meyerle, and Kim D. Edhegard have no conflicts of interest that are directly relevant to the content of this review.

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Authors and Affiliations

  1. Department of Dermatology, Walter Reed National Military Medical Center, 8901 Wisconsin Avenue, Bethesda, MD, 20889-5600, USA

    James J. Contestable & Kim D. Edhegard

  2. Department of Dermatology, Uniformed Services University of the Health Sciences, Bethesda, MD, 20814, USA

    Jon H. Meyerle

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  1. James J. Contestable
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Correspondence to James J. Contestable.

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Contestable, J.J., Edhegard, K.D. & Meyerle, J.H. Bullous Systemic Lupus Erythematosus: A Review and Update to Diagnosis and Treatment. Am J Clin Dermatol 15, 517–524 (2014). https://doi.org/10.1007/s40257-014-0098-0

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