Dermatology: Practical and Conceptual


Quiz  |  Dermatol Pract Concept 2017;7(2):15 67

DERMATOLOGY PRACTICAL & CONCEPTUAL
www.derm101.com

The Patient

A 57-year-old man presented with a one-month history of 

photosensitivity (Figures 1, 2). On physical examination ery-

thematous patches affected all parts of his face and dorsum 

of both hands. Interestingly the erythematous rash affected 

the dorsum of hands between the joints but the joints were 

spared. All laboratory tests were within normal range. A skin 

biopsy was performed, and histopathologic examination 

illustrated cutaneous lupus erythematosus.

Acute onset of a severe rash on the face 
and dorsal hands

Amir Feily1

1 Skin and Stem Cell Research Center, Tehran University of Medical Sciences, Tehran, Iran.

Citation: Feily A. Acute onset of a severe rash on the face and dorsal hands. Dermatol Pract Concept. 2017;7(2):15. DOI: https://doi.
org/10.5826/dpc0702a15

Copyright: ©2017 Feily. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which 
permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Corresponding author: Amir Feily, MD, Dr Feily Clinic of Dermatology and Hair Transplant, Moalem BLVD, Jahrom, Fars, Iran. Tel. 
00989177204638. Email: Dr.feily@yahoo.com

Figure 1. A 57-year-old man presented with a one-month history of 

photosensitivity. [Copyright: ©2017 Feily.]

Figure 2. Photosensitive rash affected the interphalangeal spaces; 

the joints were spared. [Copyright: ©2017 Feily.]

Discussion

Systemic lupus erythematosus (SLE) is a chronic disease that 

can affect any organ system. Its clinical manifestations are 

highly variable, ranging from chronic to fulminant. Cutane-



68 Quiz  |  Dermatol Pract Concept 2017;7(2):15

livedo reticularis, periungual erythema, telangiectasias, and 

Raynaud phenomenon.

Photosensitive SLE rashes basically occur on the face 

or upper extremities. It is necessary to differentiate photo-

sensitive lupus rash from a dermatomyositis rash. In lupus 

erythematosus the interphalangeal spaces are affected, but in 

dermatomyositis the erythematous rashes named Gottron’s 

papules are found over the joints and the interphalangeal 

areas are spared. Our patient was treated successfully with 

prednisolone and hydroxychloroquine without recurrence 

after 6-month follow-up.

ous lupus erythematosus (CLE) is the second most common 

finding of SLE. In a majority of cases, CLE is the main and 

sometimes the only feature of the disease independent of 

systemic involvement.

Dermatologic manifestations of lupus include malar rash, 

a fixed erythema that typically spares the nasolabial folds; 

photosensitive rash, which is often macular or diffusely 

erythematous on sun-exposed regions of the face and upper 

extremities and generally persists for more than one day; 

and a discoid rash which occurs in 20% of patients with 

SLE and can result in persistent scars. Other less specific 

cutaneous findings include alopecia, vascular lesions such as