Rheumatology Book

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Cutaneous Lupus Erythematosus

Aka: Cutaneous Lupus Erythematosus, Cutaneous Lupus, Discoid Lupus Erythematosus, Discoid Lupus, Chronic Cutaneous Lupus, Scarring Discoid Lupus, Subacute Cutaneous Lupus, Acute Cutaneous Lupus, CLE, CCLE, SCLE, ALE
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  1. See Also
    1. Systemic Lupus Erythematosus (SLE)
  2. Classification
    1. Chronic Cutaneous Lupus (CCLE) or Discoid Lupus (DLE)
      1. Peak Incidence in ages 30 to 40 years
      2. More common in women
      3. Exacerbated by trauma and sunlight
      4. Asymmetric red 1-2 cm Plaques with adherent scale
        1. Progresses to local skin atrophy over months
        2. Ultimately results in scar
          1. Scar with altered pigmentation
          2. Usually depressed, but may be hypertrophic
    2. Subacute Cutaneous Lupus (SCLE)
      1. Mid-category between CCLE and ALE
      2. Usually heals without scarring (unlike CCLE)
      3. Annular Lesion
        1. Usually involves mid-trunk
        2. Central Hypopigmentation and telangiectasia
    3. Acute Cutaneous Lupus (ALE)
      1. Red Plaques
        1. Occurs on face, chest, and Shoulders
        2. Extensor arm and hand dorsum also involved
      2. Malar Rash may also occur
  3. Labs
    1. Skin Biopsy
      1. Consider ordering immunofluorescence for older lesion
    2. Serologic testing if biopsy suggests Cutaneous Lupus
      1. ANA titer (positive if 1:160 or higher)
        1. Chronic Cutaneous Lupus (CCLE): 4%
        2. Subacute Cutaneous Lupus (SCLE): 63%
        3. Acute Cutaneous Lupus (ALE): 98%
      2. Anti-dsDNA
        1. Subacute Cutaneous Lupus (SCLE): 30%
        2. Acute Cutaneous Lupus (ALE): 60-80%
      3. Complement (C3 or CH50)
        1. Suppressed in 90% of Acute Cutaneous Lupus (ALE)
    3. Further evaluation
      1. See Systemic Lupus Erythematosus
      2. Distinguish systemic from isolated skin involvement
  4. Management
    1. Sunscreen with UVA and UVB protection is critical
    2. Topical Corticosteroids (first choice)
    3. Intralesional Corticosteroid
      1. Indicated for Discoid Lupus (DLE, CCLE)
    4. Systemic agents
      1. First-line: Hydroxychloroquine (Plaquenil)
      2. Other agents (if refractory to topicals, Plaquenil)
        1. Dapsone
        2. Oral Corticosteroids
        3. Azathioprine
        4. Isotretinoin
        5. Methotrexate
  5. References
    1. Habif (1996) Dermatology, p. 544-9
    2. Patel (2002) Dermatol Clin 20(3):373-85

Barrett Esophagus (C0004763)

Definition (NCI) Esophageal lesion lined with columnar metaplastic epithelium which is flat or villiform. Barrett epithelium is characterized by two different types of cells: goblet cells and columnar cells. The symptomatology of Barrett esophagus is that of gastro-esophageal reflux. It is the precursor of most esophageal adenocarcinomas. (WHO)
Definition (MSH) A condition with damage to the lining of the lower ESOPHAGUS resulting from chronic acid reflux (ESOPHAGITIS, REFLUX). Through the process of metaplasia, the squamous cells are replaced by a columnar epithelium with cells resembling those of the INTESTINE or the salmon-pink mucosa of the STOMACH. Barrett's columnar epithelium is a marker for severe reflux and precursor to ADENOCARCINOMA of the esophagus.
Definition (CSP) syndrome including peptic ulcer of the lower esophagus, often with stricture, due to the presence of columnar lined epithelium, which may contain functional mucous cells, parietal cells, or chief cells in the esophagus instead of normal squamous cell epithelium; sometimes pre-malignant, followed by esophageal adenocarcinoma.
Definition (NCI) A condition in which the cells lining the lower part of the esophagus have changed or been replaced with abnormal cells that could lead to cancer of the esophagus. The backing up of stomach contents (reflux) may irritate the esophagus and, over time, cause Barrett's esophagus.
Concepts Disease or Syndrome (T047)
MSH D001471
ICD9 530.85
ICD10 K22.7, K22.70
SnomedCT 235597001, 155679007, 76355008, 196609006, 302914006, 196603007
English Esophagus, Barrett, BARRETT'S ESOPHAGUS, ESOPHAGUS, BARRETT, ESOPHAGUS, COLUMNAR-LINED, Barrett's Esophagitis, Syndrome, Barrett's, CELLO - Col epith-lin low oeso, CLE - Columnar-lined oeso, Columnar epith-lined low oeso, Barrett's esophagitis, BARRETT ESOPHAGUS, BO - Barrett's esophagus, Barrett's Esophagus, Barretts Esophagus, Esophagus, Barrett's, Barrett Syndrome, Barrett's Syndrome, Barretts Syndrome, Syndrome, Barrett, Barrett's esophagus (diagnosis), barrett's esophagus, Barrett's oesophagus (disorder), Barrett's oesophagitis, ESOPHAGUS BARRETT, Barrett esophagus, Barrett Esophagus [Disease/Finding], barrett's esophagitis, barretts syndrome, barrett's oesophagitis, barrett's oesophagus, barrett esophagus, barrett's syndrome, barrett syndrome, barrett oesophagitis, barrett esophagitis, Barretts esophagus, Barretts syndrome, Barrett's esophagus NOS, Barrett's disease, Endobrachyoesophagus, Endobrachyooesophagus, Columnar-lined esophagus, Barrett's esophagus, Barrett's syndrome, Gastric metaplasia of esophagus, Barrett's oesophagus, Columnar-lined oesophagus, Gastric metaplasia of oesophagus, BO - Barrett's oesophagus, CELLO - Columnar epithelial-lined lower esophagus, CELLO - Columnar epithelial-lined lower oesophagus, CLE - Columnar-lined esophagus, CLE - Columnar-lined oesophagus, Columnar epithelial-lined lower esophagus, Columnar epithelial-lined lower oesophagus, Barrett's esophagus (disorder), Barrett, Barrett's esophagus (disorder) [Ambiguous], Barrett Esophagus, BE, Columnar Epithelial-Lined Lower Esophagus, Columnar-Lined Esophagus, CELLO, CLE, Esophagitis;Barretts, Oesophagitis;Barretts, Barretts esophagitis, Barretts oesophagitis
Dutch Barret-oesophagus, endobrachyoesophagus, Barrett-oesophagitis, Barrett-oesophagus, Barrett-oesofagus, Barrett-syndroom, Oesofagus, Barrett-
French Oesophagite de Barrett, Endobrachyoesophage, Endo-brachy-oesophage de Barrett, Endobrachy-oesophage de Barrett, Oesophage de Barrett (diagnostic), Oesophage de Barrett, Syndrome de Barrett
German Barrett-Oesophagitis, Endobrachyoesophagus, Barrett-Ulkus, Barrett-Syndrom, Barrett-Ösophagus, Ösophagus, Barrett-
Italian Endobrachiesofago, Esofagite di Barrett, Sindrome di Barrett, Esofago di Barrett (diagnosi), Esofago di Barrett
Portuguese Endobraquiesófago, Esofagite de Barrett, Esófago de Barrett, Esôfago de Barrett, Síndrome de Barrett
Spanish Endobraquioesófago, Esofagitis de Barrett, Barrett's oesophagus, Barrett's esophagus, síndrome de Barret, epitelio columnar en el esófago distal, esófago con epitelio columnar, esófago de Barret (concepto no activo), esófago de Barret (trastorno), esófago de Barret, metaplasia gástrica de esófago, metaplasia gástrica del esófago, síndrome de Barrett, esófago de Barret [dup] (trastorno), Esofago de Barrett, Esófago de Barrett, Síndrome de Barrett, Sindrome de Barrett
Japanese 食道円柱上皮化, ﾊﾞﾚｯﾄｼｮｸﾄﾞｳ, ｼｮｸﾄﾞｳｴﾝﾁｭｳｼﾞｮｳﾋｶ, Barrett食道, Barrett症候群, バレット食道, バレット症候群, 食道-バレット
Swedish Barretts esofagus
Czech Barrettův ezofágus, Endobrachyezofagus, Barretův jícen
Finnish Barrettin ruokatorvi
Russian BARRETA PISHCHEVOD, PISHCHEVOD BARRETA, БАРРЕТА ПИЩЕВОД, ПИЩЕВОД БАРРЕТА
Korean 바렛 식도
Polish Wrzód trawienny przełyku, Przełyk Barretta
Hungarian Barrett oesophagitis, Endobrachyoesophagus, Barrett-oesophagus, Barrett oesophagus
Sources
Derived from the NIH UMLS (Unified Medical Language System)


Lupus Erythematosus, Discoid (C0024138)

Definition (MSH) A chronic form of cutaneous lupus erythematosus (LUPUS ERYTHEMATOSUS, CUTANEOUS) in which the skin lesions mimic those of the systemic form but in which systemic signs are rare. It is characterized by the presence of discoid skin plaques showing varying degrees of edema, erythema, scaliness, follicular plugging, and skin atrophy. Lesions are surrounded by an elevated erythematous border. The condition typically involves the face and scalp, but widespread dissemination may occur.
Definition (CSP) chronic form of cutaneous lupus erythematosus in which the skin lesions mimic those of the systemic form but in which systemic signs are rare; characterized by the presence of discoid skin plaques showing varying degrees of edema, erythema, scaliness, follicular plugging, and skin atrophy; lesions are surrounded by an elevated erythematous border; the condition typically involves the face and scalp, but widespread dissemination may occur.
Concepts Disease or Syndrome (T047)
MSH D008179
ICD10 L93.0
SnomedCT 13902000, 156365002, 200938002, 238927000
English Lupus Erythematosus, Chronic Cutaneous, Lupus Erythematosus, Discoid, DISCOID LUPUS, DISCOID LUPUS ERYTHEMATOSIS, Lupus Erythematosus, Cutaneous, Chronic, DLE, LUPUS ERYTHEMATOSIS DISCOID, LUPUS ERYTHEMATOSUS DISCOID, LUPUS ERYTHEMATOSUS, DISCOID, Lupus erythematosus, discoid, DLE - Discoid lupus erythemat, LE-Discoid lupus erythematosus, CDLE - Chronic discoid LE, Chron discoid lupus erythemat, lupus, lupus erythematosus discoid (diagnosis), lupus erythematosus discoid, discoid lupus erythematosus, Discoid lupus, Discoid lupus erythematosis, Lupus erythematosis discoid, Lupus erythematosus discoid, Lupus erythematosus discoides, LUPUS DISCOID, Lupus Erythematosus, Discoid [Disease/Finding], dle, discoid lupus erythematosis, discoid lupus, discoid lupus erythematosus (DLE), lupus discoid, Chronic cutaneous lupus erythematosus, Discoid lupus erythematosus, DLE - Discoid lupus erythematosus, LE - Discoid lupus erythematosus, CDLE - Chronic discoid lupus erythematosus, Chronic discoid lupus erythematosus, Chronic discoid lupus erythematosus (disorder), Discoid lupus erythematosus (disorder), discoid; lupus, lupus; discoid, Discoid lupus erythematosus (disorder) [Ambiguous], Discoid Lupus Erythematosus, Lupus discoid, Discoid lupus erythematous
French LUPUS ERYTHEMATEUX DISCOIDE, LED, Lupus érythémateux chronique, Lupus érythémateux discoïde, Lupus érythémateux cutané chronique
Portuguese LUPUS ERITEMATOSO DISCOIDE, Lupus eritematoso discóide, Lúpus eritematoso discóide, Lúpus eritematoso cutâneo crónico, LUPUS ERITEMATOSO DISSEMINADO, Lupus Eritematoso Cutâneo Crônico, Lupus Eritematoso Discóide
Spanish LUPUS ERITEMATOSO DISCOIDE, Lupus eritematoso discoide, Lupus eritematoso cutáneo crónico, Discoid lupus erythematosus, lupus eritematoso discoide crónico (trastorno), lupus eritematoso discoideo crónico (trastorno), lupus eritematoso discoide crónico, LED, lupus eritematoso discoide (trastorno), lupus eritematoso discoideo (concepto no activo), lupus eritematoso discoideo (trastorno), lupus eritematoso discoideo crónico, lupus eritematoso discoideo, lupus eritematoso discoide, Lupus Eritematoso Cutáneo Crónico, Lupus Eritematoso Discoide, Lupus Eritematoso Cutaneo Cronico
Dutch discoïde lupus erythematodes, chronische cutane lupus erythematosus, DLE, discoïd; lupus, lupus; discoïd, Lupus erythematosus discoides, Lupus erythematosus, chronische cutane, Discoïde lupus erythematodes
German Lupus erythematosus diskoid, diskoider Lupus erythematosus, DLE, chronischer kutaner Lupus erythematodes, Lupus erythematosus diskoides, Lupus erythematodes discoides, Diskoider Lupus erythematodes, LE DISCOIDES, LE DISSEMINIERT, Lupus erythematodes, chronischer kutaner, Lupus erythematodes, diskoider, Lupus erythematodes, kutaner, chronischer
Italian Lupus eritematoso cutaneo cronico, Lupus eritematoso discoide (disseminato), Lupus eritematoso cronico cutaneo, Lupus eritematoso discoide
Swedish Lupus erythematosus, diskoid
Japanese ｴﾝﾊﾞﾝｼﾞｮｳｴﾘﾃﾏﾄｰﾃﾞｽ, ﾏﾝｾｲﾋﾌｴﾘﾃﾏﾄｰﾃﾞｽ, ＤＬＥ, DLE, エリテマトーデス-円板状, 円板状エリテマトーデス, 円板状紅斑性狼瘡, 慢性円板状エリテマトーデス, 慢性皮膚エリテマトーデス, 紅斑性狼瘡-円板状, エリテマトーデス-慢性皮膚, エリテマトーデス-皮膚-慢性, 慢性皮膚エリトマトーデス
Czech lupus erythematosus diskoidní, Chronický kožní lupus erythematosus, Diskoidní lupus erythematosus
Finnish Diskoidi lupus erythematosus
Russian VOLCHANKA ERITEMATOZNAIA KHRONICHESKAIA KOZHNAIA, VOLCHANKA KRASNAIA DISKOIDNAIA, VOLCHANKA KRASNAIA KHRONICHESKAIA KOZHNAIA, VOLCHANKA ERITEMATOZNAIA DISKOIDNAIA, PEREKLIUCHAIUSHCHII KOMPLEKS, ВОЛЧАНКА КРАСНАЯ ДИСКОИДНАЯ, ВОЛЧАНКА КРАСНАЯ ХРОНИЧЕСКАЯ КОЖНАЯ, ВОЛЧАНКА ЭРИТЕМАТОЗНАЯ ДИСКОИДНАЯ, ВОЛЧАНКА ЭРИТЕМАТОЗНАЯ ХРОНИЧЕСКАЯ КОЖНАЯ, ПЕРЕКЛЮЧАЮЩИЙ КОМПЛЕКС
Korean 원판상 홍반성 루푸스
Croatian LUPUS, ERITEMSKI DISKOIDNI
Polish Toczeń rumieniowaty ogniskowy, Liszaj rumieniowaty przewlekły
Hungarian Lupus erythematosus discoid, discoid lupus erythematosus, Chronikus cutan lupus erythematosus, Discoid lupus erythematosus, Discoid lupus erythematosis, Discoid erythemás lupus, DLE
Sources
Derived from the NIH UMLS (Unified Medical Language System)


ale beer (C0678386)

Concepts Food (T168)
English ale, ale beer, ales
Sources
Derived from the NIH UMLS (Unified Medical Language System)


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