Bullous systemic lupus erythematosus (BSLE) is a rare form of cutaneous lupus.
Clinical features:
(1) tense vesiculobullous eruption
(2) more often seen in sun-exposed skin
(3) pruritic
(4) may be drug-induced
Autoantibodies may include:
(1) type VII collagen
(2) BP180 and/or BP230
(3) laminin 5 and/or laminin 6
A biopsy of affected skin shows:
(1) subepidermal blisters
(2) neutrophilic infiltrate along the basement membrane
(3) IgG deposition at the dermo-epidermal junction on immunofluorescence.
Histologic subtypes:
(1) dermatitis herpetiformis-like
(2) epidermolysis bullosa acquisita-like
(3) bullous pemphigoid-lie
The patient may also have:
(1) esophagitis with odynophagia
(2) lupus nephritis
(3) other mucosal involvement
The diagnosis requires exclusion of other conditions with bullae.
