SLE Rash Sparing the Sunlight Hidden Area under Saree in an Indian Lupus Patient

Pradeep, S.¹ & Ritasman Baisya^2*

¹DM Resident, Clinical Immunology and Rheumatology, NIMS
²Assistant Professor, Clinical Immunology and Rheumatology, NIMS

*Correspondence to: Dr. Ritasman Baisya, Assistant Professor Rheumatology, Department of Clinical Immunology and Rheumatology, NIMS Nizam’s Institute of Medical Sciences.

Copyright © 2023 Dr. Ritasman Baisya, et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Clinical Image: This middle-aged female presented with recent onset fever, weight loss, inflammatory polyarthritis, non-scarring alopecia, palatal ulcer and rash over face, neck and right upper chest and upper back. On examination, erythematous plaque-like lesions with central blackish pigmentation were noticed behind right and left ear but the rash was extended to the right aspect of lower neck, upper chest and upper back, sparing the adjacent left side. Due to its dermatomal-like distribution, herpes zoster was kept as a possibility, but the patient denied any vesicular lesion. It was found that the rashes are completely absent in the area of skin covered by ‘saree’ (a women’s garment from the Indian subcontinent) and do not follow any typical dermatomal distribution. It was diagnosed as acute cutaneous lupus (ACLE) sparing the sun-light hidden area under ‘saree’ in an Indian lupus patient indicating typical photosensitive characteristics of rash in lupus. She also had history of fever, inflammatory polyarthritis with positive antinuclear antibody, dsDNA and low complement level fulfilling the classification criteria of systemic lupus erythematosus (SLE).

Uniqueness: Cutaneous lupus rash (CLE) is well characterized by photosensitivity and is more common in sun-exposed areas. In India, where ‘saree’ is a common attire for more than 90% of females, a unique distribution of CLE can be seen. In this case, the skin covered by the ‘saree’ does not show any rash while the exposed skin shows CLE rash. To date, no such image of this uniquely distributed photosensitive CLE has been published. In the context of Indian socio-cultural norms, this picture depicts the varying dispersion of CLE in areas exposed to sunlight.