Vesiculobullous diseases in relation to lupus erythematosus

Abstract

Vesiculobullous lesions in lupus erythematosus (LE) are a rare cutaneous manifestation of cutaneous and/or systemic LE with variable presentation. While the minor forms of LE-associated vesiculobullous disease may cause disfigurement and discomfort, the severe forms can present with hyperacute reaction and life-threatening consequences. Specific LE and aspecific cutaneous LE are defined by the presence or absence of interface change on histopathology that can be applied to vesiculobullous diseases in relation to LE. However, the diagnosis of LE-associated vesiculobullous diseases remains difficult, due to the poorly defined nosology and the similarities in clinical and immunohistopathological features among them. Herein, we thoroughly review the topic of vesiculobullous skin disorders that can be encountered in LE patients and organize them into four groups: LE-specific and aspecific vesiculobullous diseases, LE-related autoimmune bullous diseases, and LE in association to non-autoimmune conditions. We sought to provide an updated overview highlighting the pathogenesis, clinical, histological, and immunopathological features, laboratory findings, and treatments and prognosis among vesiculobullous conditions in LE.

Keywords:

• autoimmune blistering diseases
• erythema multiforme
• cutaneous lupus erythematosus
• systemic lupus erythematosus
• Stevens–Johnson syndrome
• toxic epidermal necrolysis

Acknowledgment

We acknowledge the assistance of Dr Poonkiat Suchonwanit in the preparation of illustrations.

Statement of ethics

The patients provided written informed consent to perform all necessary investigations, to take clinical photographs, and to use them for research purposes and publication.

Disclosure

The authors report no conflicts of interest in this work.