Neonatal Lupus Erythematosus

Joanna M. Burch, Lela A. Lee and William L. Weston


Dermatology Nursing. 2002;14(3) 

In This Article

Skin Findings

Neonatal lupus skin lesions often appear in the first few weeks of life, but may be present at birth. Cutaneous lesions are often erythematous lesions, raised or flat, sometimes with fine scale. They may also be annular (see Figure 1). The vast majority of NLE infants (90% to 95%) will have lesions on the face and scalp (see Figure 2), although they do occur on the trunk and extremities as well. Extremity lesions are common, occurring in up to 75% of cases. Erythematous, scaly plaques in a periorbital, or "owl-eye" distribution are very specific for cutaneous NLE (see Figure 3), and papulosquamous lesions in this distribution must prompt clinician consideration of this diagnosis. Greater than half of patients will have notable photosensitivity.

Neonate with scaly annular lesions of NLE on the face and scalp.

Close-up of scalp lesion.

The classic "owl-eye" distribution in neonates with NLE.

In a retrospective study of 18 patients with NLE by Weston, males tended to have more crusted lesions. The presence of more crusted skin lesions significantly correlated with extracutaneous involvement, such as cholestasis, or hematologic abnormalities. In followup, the skin eruptions cleared in all patients by 7 months of age, leaving residual telangiectasias in four infants. The residual telangiectasias were present at followup ranging from 3 to 8 years. Five infants had residual dyspigmentation (both hypo [2] and hyperpigmentation [3]) lasting 1 to 4.5 years. No child had atrophy or permanent scarring. Interestingly, four infants had cutis marmorata telangiectasia congenita, which has been reported with NLE in the past (Weston, Morelli, & Lee, 1999). A biopsy of lesional skin is consistent with cutaneous lupus. There is vacuolar alteration of the basal cell layer with a sparse superficial dermal mononuclear cell infiltrate. Direct immunofluorescence (IF) in these patients reveals granular deposition of IgG. This is to be expected, as only IgG can cross the placenta from the mother. Adults with subacute cutaneous lupus erythematosus will have IgG and IgM deposits on IF of skin lesions (Lee, 1993).


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