Challenging Adult and Pediatric Autoimmune Connective Tissue Disease Cases: Pearls for Diagnosis and Management

The presentation discusses complex cases of autoimmune connective tissue diseases in adults and children, focusing on diagnosis and treatment strategies. A 65-year-old female patient with discoid lupus erythematosus (DLE) and concomitant palmoplantar pustular psoriasis struggled with treatment regimens, including hydroxychloroquine, methotrexate, and acitretin, prompting the consideration of dupilumab. Ducravacitinib, a new TIC2 inhibitor FDA-approved for psoriasis, was eventually introduced and resulted in significant improvement for both conditions. Additionally, a case of a 46-year-old female with dyscoid lupus in the context of systemic lupus erythematosus (SLE) highlights treatment challenges with post-inflammatory hyperpigmentation (PIH), where non-ablative fractional laser treatments successfully improved her skin without triggering disease flare-ups. The discussion extends to management of sequelae in other autoimmune skin diseases, such as microstomia in scleroderma, for which hyaluronidase injections were effective, along with cosmetic interventions for perioral furrows and telangiectasias. The presentation emphasizes the importance of addressing not only the primary autoimmune disease but also its sequelae to enhance patients' quality of life.