The diagnosis should be suspected based on the maternal history of anti-Ro/La antibodies, a previous child with NLE, or autoimmune disease, especially photosensitivity, dry eyes, and dry mouth. It is important to keep in mind that many mothers are asymptomatic at the time the affected infant is born.
The clinical features of early onset of scaly plaques on the face, scalp, and extremities, especially in a periorbital distribution, must prompt consideration of NLE. Obviously, infants with complete heart block likely have NLE.
A thorough maternal history and review of symptoms must be done. If the diagnosis is suspected, a maternal ANA and anti-Ro and anti-La antibodies are reasonable. The baby's sera may be tested for anti-Ro and La as well. A complete blood count, liver function tests, and an ECG should be done to rule out extracutaneous involvement.
If the neonate has cutaneous lesions, and the diagnosis is in question, a biopsy of lesional skin may be taken. The specimen should be sent for hematoxylin and eosin (H & E) staining. Direct immunofluorescence can be a helpful additional evaluation. The presence of anti-Ro and/or La in the infant and maternal serum may prevent the need for a biopsy. Photographic documentation of the infant may help clarify the diagnosis retrospectively if there is uncertainty regarding the diagnosis.
Dermatology Nursing. 2002;14(3) © 2002 Jannetti Publications, Inc.
Cite this: Neonatal Lupus Erythematosus - Medscape - Jun 01, 2002.