What Is Lupus Erythematosus Panniculitis?
Lupus erythematosus panniculitis (LEP) is a rare variant of systemic lupus erythematosus (SLE) that is marked by the formation of inflammatory nodular lesions over the skin. The layer of the skin it usually affects is termed the panniculus, which is the layer of subcutaneous fat that is present just below the skin. The nodular lesions are quite large, indurated, and may or may not be asymptomatic. The majority of these lesions are found to form in the fatty areas of the skin, such as the face, breast, thighs, and buttocks. Women are more likely to be affected by this disease compared to men. LEP is an autoimmune disease, and just like all other autoimmunity-mediated diseases, the exact reason for its incidence is quite unclear. In panniculitis disease, the healthy tissue of the fat layer present below the skin is attacked by the immune system, which leads to inflammation of the panniculus. Over time, symptoms are noticeable. LEP is generally reported to occur as a manifestation of a co-existing disease such as systemic lupus erythematosus (SLE). However, its incidence in an isolated manner has also been reported previously.
What Are the Symptoms Of Lupus Erythematosus Panniculitis?
The characteristic hallmark of this disease is the formation of painful, tender nodules under the skin. These nodules are about one to five centimeters in dimension and do not resolve in a short time. LEP disease is an inflammatory response observed in the subcutaneous fat. The nodules may transition to much-advanced skin lesions with chronic and persistent inflammation. It is relatively much easier to spot these nodules on white-skinned people compared to people with darker tones.
What Is Drug-Induced Lupus Erythematosus?
Multiple theories have been proposed to explain autoimmunity. The three widely accepted reasons are genetic makeup or family history, environmental factors, and immunological factors. In some instances, the usage of specific drugs has also led to the incidence of lupus. Upon cessation of the drug, the lupus tends to resolve over time. This particular phenomenon is referred to as drug-induced lupus erythematosus. The prolonged exposure to the drug or the offending agent triggers the immune system to get hyperactivated and act abnormally. According to data, about 10 percent of SLE patients are a victim of drug-induced lupus erythematosus (DILE). At present, numerous medications are said to precipitate the symptoms of lupus. Some of these are namely Hydralazine, Minocycline, Sulfadiazine, fluorouracil agents, and recently, tumor necrosis factor-alpha (TNF-α) inhibitors such as those used in rheumatoid arthritis.
What Is Abatacept?
Abatacept is a recently approved drug prescribed to manage the symptoms of rheumatoid arthritis. The usage of the drug did prove to be efficacious for rheumatic patients to an extent. However, not much data is collected on the side effects incurred upon prolonged exposure to Abatacept. Approximately fewer than 10 patients have reported the incidence of lupus panniculitis as an adverse reaction to Abatacept, with the most common reactions associated with oral contraceptives, nonsteroidal anti-inflammatory drugs, antibiotics, and leukotriene-modifying agents.
Abatacept, Etanercept, and Infliximab belong to the class of biological agents that are gaining popularity in treating rheumatoid arthritis. The course of action Abatacept undergoes to induce LEP as a consequence remains unclear. The clinical history of the patient, complemented with an accurate pathological assessment, is a reliable source to diagnose drug-induced lupus erythematosus. A marked increase in antinuclear antibodies (ANA) is observed in patients with LEP.
How To Manage Lupus Erythematosus Panniculitis?
The management of drug-induced panniculitis is carried out by stopping the administration of the concerned drug or removing the offending agent completely. When the stimulus is abruptly taken back, the response to the stimulus also ceases to exist with time.
LEP in general, is said to be managed effectively by various means:
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The first line of treatment administered to patients suffering from LEP is steroids. These are taken either orally, applied topically, or injected directly into the panniculitis lesions.
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The second commonly administered drug includes antimalarial drugs like Hydroxychloroquine or Plaquenil. The disease flare-ups are observed to be manageable with a treatment plan involving these two therapies. However, remission of the disease is quite a possibility as there is no definite cure for lupus found to date.
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In cases where antimalarial agents fail to ease the symptoms of cutaneous lupus erythematosus, thalidomide or mycophenolate mofetil are administered. Cases showing complete remission have been observed by opting for the latter course of therapy.
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The inflammatory lesions associated with panniculitis are quite painful and may lead to evident tissue loss and scarring. The nodules develop in areas involving the face and upper and lower extremities. This can lead to a significant loss of self-esteem in LEP patients and have a deteriorating effect on their mental well-being. The psychological impact caused by LEP also needs to be addressed when considering the treatment plan for panniculitis disease. Consulting a mental health therapist is a good start to overcoming this aspect of the disease. Apart from this, the skin damage and tissue loss can be compensated for with the help of dermal filler injections. However, the doctor’s approval for initiating such treatment needs to be obtained as people with autoimmune disorders are highly unlikely to show a good prognosis for filler treatments.
Conclusion
Rheumatologic patients are administered varied amounts of drugs to cater to all their symptoms associated with joint pain, flare-ups, muscular fatigue, and other clinical manifestations presented in singular or multiple organ systems. This calls for doctors to keep a cautious eye on the suitability of the drugs prescribed, along with any adverse signs or symptoms that may have been precipitated as a result of a certain drug usage. It is equally essential for the patient to be alert to any adverse drug reactions experienced. One must make no delay in informing about the incident to the concerned doctor in such circumstances.
