A Natural Journey to Remission: Confronting Acute Cutaneous Lupus Erythematosus 皮肤型红斑性狼疮
Case Reports
It started innocuously enough – a fit 40-year-old woman noticed that her cheeks felt unusually tight and sore. Upon examining her face in the mirror, she discovered a vivid reddish rash spanning both cheeks and the bridge of her nose. The well-defined rash stood out brightly against her pale skin, feeling warm and slightly stingy to the touch. Over the following couple of months, the localized facial rash progressively intensified – her cheeks took on a sunburnt appearance with small fluid-filled bumps emerging on top of the redness. Swelling developed and her face felt hot and tender to contact.
Seeking relief from the burning rash and swelling, she initially tried over-the-counter hydrocortisone cream to no avail. She then consulted with the dermatology department at her local hospital, where she was diagnosed with acute cutaneous lupus erythematosus (ACLE) based on a positive ANA blood test. According to the doctor, ACLE is an inflammatory autoimmune skin condition with no definitive cure. Given the unlikelihood of spontaneous resolution, immunosuppressant therapy was recommended to manage her facial lesions.
Unwilling to immediately proceed with immunosuppressants, she visited our clinic seeking a third opinion and expressing interest in alternative natural medicine approaches. Opting for a holistic approach, she embarked on a journey guided by tailored herbal formulas. Remarkably, her ACLE entered remission, and the facial rash that once seemed indomitable took just four months to fully clear. Immunology testing, including ANA, revealed a surprising negative result.
This compelling case not only sheds light on the potential effectiveness of natural medicine alternatives for managing certain autoimmune skin conditions, but also underscores the possibility of facilitating disease remission and relief through personalized, herb-based interventions. Such holistic approaches may offer hope and a refreshing perspective for those struggling with similar inflammatory or immune-mediated challenges. By detailing this woman’s illuminating experience, we aim to broaden awareness around integrative treatment options and their capacity to align with the body’s innate self-healing wisdom – guiding it gently back toward homeostasis and health.
What is Acute cutaneous lupus erythematosus (ACLE) ?
Acute cutaneous lupus erythematosus (ACLE) is a form of cutaneous lupus characterized by a red, raised rash that appears on sun-exposed areas like the face and upper body. The rash develops rapidly over hours to days and typically resolves over several weeks, leaving temporary skin discoloration. ACLE is one manifestation of the autoimmune disease systemic lupus erythematosus (SLE) but can also occur independently without progression to SLE.
The exact cause is unknown but is related to photosensitivity, where sunlight exposure triggers an inflammatory reaction in susceptible individuals. Skin lesions are thought to result from the binding of autoantibodies to components of the epidermis and dermis in sun-exposed areas. Diagnosis is made clinically through evaluation of the rash and ruling out other causes. Skin biopsy can confirm by showing interface dermatitis.
First-line treatment focuses on sun protection with high SPF sunscreens, protective clothing, and behavior modification. Topical steroids help reduce inflammation and itching. For severe or refractory cases, systemic immunosuppressants like hydroxychloroquine or prednisone may be used. Most cases resolve without scarring but some postinflammatory dyspigmentation may remain temporarily. Monitoring for progression to SLE is recommended.
How is acute cutaneous lupus diagnosed?
ANA, or antinuclear antibody testing, detects autoantibodies against various nuclear antigens. While not diagnostic on its own, detecting ANA is useful in supporting a diagnosis of ACLE or systemic lupus erythematosus (SLE).
About 70% of those with ACLE will test positive for ANA. However, a negative ANA does not rule out the disease as about 30% can still be ANA negative. If clinical evaluation and skin biopsy support ACLE but ANA is negative, further serological testing can be done for anti-Ro/SSA and anti-La/SSB antibodies which can also be present.
A positive ANA provides evidence of an autoimmune process and serological marker to monitor disease activity and progression. Negative ANA does not exclude ACLE though, and clinicians should rely more on the characteristic rash and skin histology for definitive diagnosis in those cases. Serial ANA testing can reveal whether autoantibodies develop over time as that may indicate evolution toward SLE.
The strength of the positive ANA can also correlate with disease severity. So ANA testing serves an adjunct role in diagnosis, gauging disease severity, and predicting progression in ACLE patients.
Privacy
In situations where the disease information had already been made publicly available (as evidenced by prior articles), genuine names of individuals have been utilized. Conversely, in instances where there was no pre-existing public disclosure or at the explicit request of patients for privacy, pseudonyms have been employed. Furthermore, identities have been deliberately obscured, and certain contextual details and diagnoses have been modified to hinder any attempts at identification. It is essential to emphasize that the patients and encounters described in this work are authentic, and their consent for publication was duly obtained. As responsible authors, we earnestly implore all our readers to honor the privacy and confidentiality of these individuals. Additionally, certain scenarios, assessments, and clinical interventions have been altered to safeguard the anonymity of both patients and healthcare providers.
