When a patient initially presents with<unk><unk> , the doctor should ensure that the patient does not have systemic<unk>  erythematosus. The doctor will order tests to check for anti-nuclear antibodies in the patient's serum, low white blood cell<unk> vels, and protein and/or blood in the urine. In order to help with diagnosis, the doctor may peel off the top layer of scale from a patient's<unk> sions in order to look at its underside. If the patients do indeed have<unk><unk> , the doctor may see tiny spines of keratin that look like carpet tacks and are called langue au chat. Diagnosis is confirmed through biopsy. Typical biopsy findings include deposits of IgG and IgM antibodies at the dermoepidermal junction on direct immunofluorescence. This finding is 90% sensitive; however, false positives can occur with biopsies of facial<unk> sions. In addition, pathologists often see groups of white blood cells, particularly T helper cells, around the follicles and blood vessels in the dermis. The epidermis appears thin and has effaced rete ridges as well as excess amounts of keratin clogging the openings of the follicles. The basal layer of the epidermis sometimes appears to have holes in it since some of the cells in this layer have broken apart. The remains of skin cells that have died through a process called apoptosis are visible in the upper layer of the dermis and the basal layer of the epidermis. The differential diagnosis includes actinic keratoses, sebborheic dermatitis,<unk>  vulgaris, sarcoidosis, drug rash, Bowen’s disease, lichen planus, tertiary syphilis, polymorphous light eruption, lymphocytic infiltration, psoriasis, and systemic<unk>  erythematosus. Classification<unk><unk>  can be broadly classified into localized<unk><unk>  and generalized<unk><unk>  based on the location of the<unk> sions. Patients who develop<unk><unk>  in childhood also have their own sub-type of disease. Hypertrophic<unk>  and<unk>  profundus are two special types of<unk><unk>  distinguished by their characteristic morphological findings. Finally, many patients with systemic<unk>  also develop<unk><unk> <unk> sions. Localized Most people with<unk><unk>  only have<unk> sions above the neck and therefore have localized<unk> . Generalized Rarely, patients may have<unk> sions above and below the neck; these patients have generalized<unk> . In addition to<unk> sions in the typical above-the-neck locations, patients with generalized<unk><unk>  often have<unk> sions on the thorax and the arms. These patients are often bald, with abnormal skin pigment on their scalp, and have severe scarring of the face and arms. Patients with generalized<unk><unk>  often have abnormal lab tests, such as an elevated ESR or a low white blood cell count. They also often have auto-antibodies, such as ANA or anti-ssDNA antibody. Childhood When patients develop<unk><unk>  in childhood, it differs from typical<unk><unk>  in several ways. Boys and girls are equally affected, and these patients later develop SLE more often. These patients also typically do not have any abnormal sensitivity to the sun. Special types of<unk><unk> <unk> sions Hypertrophic<unk>  Some experts consider hypertrophic<unk>  erythematosus—which consists of<unk> sions covered by a very thick, keratin-filled scale—an unusual subset of<unk><unk> . Others consider it a distinct entity.<unk>  profundus If a patient has<unk><unk> <unk> sions on top of<unk>  panniculitis, they have<unk>  profundus. These patients have firm, nontender nodules with defined borders underneath their<unk><unk> <unk> sions. Systemic<unk>  erythematosus with<unk><unk> <unk> sions In general, patients with<unk><unk>  who have only skin disease and no systemic symptoms have a genetically distinct disease from patients with SLE. However, 25% of patients with SLE get<unk><unk> <unk> sions at some point as part of their disease.
Discoid lupus erythematosus
Chilblain lupus erythematosus
Tumid lupus erythematosus
Drug-induced lupus erythematosus
Lupus erythematosus
Lupus vulgaris
Scleroderma
Arthritis mutilans