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Dr. Andrew Rynne
MD
Dr. Andrew Rynne

Family Physician

Exp 50 years

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Is A Sensitive Rash On The Arms And Face Related To Subcutaneous Lupus?

I have recently had a skin punch biopsy for a light sensitive rash on my arms and face. I saw an allergist first who tested me and said the rash was not associated with any allergies. He sent me to a dermatologist who does research at NIH who immediately said he thought I had lupus. The skin biopsy revealed vacuolar interface dermatitis with rare dyskeratotic keratinocytes with an early lesion of erythema multiforme. Blood work revealed Sjorgren s Anti-SS-A of 8.0 and Sjogren s Anti-SS-B of 1.5...The ANA Direct was positive. Isaw a highly recommended rheumatologist in the DC/MD area where I live. Because I also have dry mouth from medications that I take, she diagnosed me with only Sjogren s disease and subscribed Plaquenil. She says I do not have lupus. A friend who is a resident and rheumatology resident at Emory University says she thinks it is subacute cutaneous Lupus. In the last few months, I have developed fatigue, muscle and joint pain and have difficulty remembering names and words. My doctor also did not do an immunefluorescence test..she said I did not need it. My doctor friend could not understand why she would not do it and the dermatologist who reviewed my test results with me told me he thought it was absolutely Lupus and that I would probably be sent back to him for that test. I have an upcoming appt. with the rheumatologist on Feb. 2, but my family thinks I need to change doctor s after the conflicting information. Help, do I have subacute cutaneous Lupus Plus Sjorgen s or maybe starting to develop SLE by itself. I am very confused and do not want to be misdiagnosed.
Mon, 16 Apr 2018
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Rheumatologist 's  Response
Hello,

When you have Sjögren's syndrome, it can be a part of lupus and so is the skin rash, as you have systemic symptoms: fever, arthritis, etcetera. It will help to get the Antinuclear Antibody Panel ( ANA ) and ANA panel and start you on prednisone and other medications for systemic lupus, which works for skin and Sjögren's syndrome: Imuran or Cellcept.


Hope I have answered your query. Let me know if I can assist you further.

Regards,
Dr. Priya Sadanandan
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Is A Sensitive Rash On The Arms And Face Related To Subcutaneous Lupus?

Hello, When you have Sjögren s syndrome, it can be a part of lupus and so is the skin rash, as you have systemic symptoms: fever, arthritis, etcetera. It will help to get the Antinuclear Antibody Panel ( ANA ) and ANA panel and start you on prednisone and other medications for systemic lupus, which works for skin and Sjögren s syndrome: Imuran or Cellcept. Hope I have answered your query. Let me know if I can assist you further. Regards, Dr. Priya Sadanandan