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Background
An understanding of skin conditions associated with rheumatic diseases ensures accurate diagnosis and management. Cutaneous manifestations of rheumatological disease are legion.
Objective
The aim of this article is to increase clinician familiarity with the dermatological manifestations of rheumatic conditions to enable accurate diagnosis and effective management.
Discussion
This article will address the skin manifestations of lupus erythematosus, rheumatoid arthritis, psoriatic arthritis, dermatomyositis and scleroderma, including their implications in diagnosis, prognosis and treatment.
SEVERAL SKIN MANIFESTATIONS have been described in the presentation of, association with and progression of various rheumatic diseases. In addition to their medical implications, these skin manifestations can be a source of patient distress as a result of symptomatology and cosmesis.1 Cutaneous features may precede, co-exist with or follow development of the rheumatic disease. Cutaneous manifestations may allow diagnosis of rheumatological disorders.
The aim of this article is to provide a review of the cutaneous features of five common rheumatological conditions: lupus erythematosus, rheumatoid arthritis, psoriatic arthritis, dermatomyositis and scleroderma.
Lupus erythematosus
Lupus is an autoimmune connective tissue disease classified into systemic lupus erythematosus (SLE) and cutaneous lupus erythematosus (CLE). Clinical disease occurs due to autoantibody formation and immune complex deposition, which lead to pro-inflammatory cytokine production and organ damage. SLE can occur in the absence of cutaneous features, and CLE can occur without systemic disease. Clinical features vary, and various cutaneous manifestations may be seen.2
The skin manifestations may be classified into subtypes. Their key features are outlined in Table 1.1-4
Other dermatological associations of lupus include alopecia (as a primary skin manifestation or secondary to CLE), oronasal ulcers, nail dystrophy, digital ulcers, vasculitis and livedo reticularis.5
Key triggers include ultraviolet (UV) exposure and smoking, although various infections and environmental pollutants are also implicated. Smoking increases the risk of therapeutic resistance and refractory disease. Females and those of African and Hispanic descent are at increased risk when compared with the general population.2'5-7 A wide range of medications may trigger drug-induced lupus. Procainamide, hydralazine, quinidine and minocycline are commonly implicated in acute CLE. Terbinafine, proton pump inhibitors, anti-epileptics and biologics including tumour necrosis factor alpha (TNF-a) inhibitors are described culprits in subacute CLE. It should be noted that the use of TNF-a inhibitors may result in positive lupus autoantibodies; however, clinical...