CPQ Medicine (2023) 15:1Clinical Image
SLE Rash Sparing the Sunlight Hidden Area under Saree in an Indian
Pradeep, S.1 & Ritasman Baisya2*
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.
Received: 02 April 2023
Published: 10 July 2023
Keywords: Systemic Lupus Erythematosus (SLE); Acute Cutaneous Lupus (ACLE); Cutaneous Lupus
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.
Figure: Erythematous plaque with central black scar over right upper chest and back , sparing the area covered by