Skinternal Medicine: An Update on Cutaneous Manifestations of Systemic Disease

In a presentation on cutaneous manifestations of systemic diseases, a detailed case of a 32-year-old woman with lupus and rheumatoid arthritis was discussed. She had experienced severe skin reactions after resuming medications like hydroxychloroquine, which had previously caused rashes unless she was on prednisone. Upon her hospital admission, she exhibited diffuse rash, fever, pleuritic chest pain, and significant laboratory abnormalities including elevated liver enzymes and low platelets. Following a workup, her skin condition showed full-thickness necrosis, indicative of toxic epidermal necrolysis (TEN), but further evaluations suggested it was an acute cutaneous lupus erythematosus (ACLE). The talk explored associations between hydroxychloroquine and severe cutaneous adverse reactions, particularly highlighting that certain autoimmune diseases like dermatomyositis might increase these risks. It also discussed diagnostic considerations, histopathological findings, and treatment responses, reinforcing that rapid recovery is often seen in TEN-like lupus with systemic corticosteroids. The importance of a thorough investigation when encountering similar cases was emphasized, alongside a reminder that lupus may manifest through unexpected skin reactions, serving as a vital clue for diagnosis.