Rheumatology Case 4

A 52 year old woman with a long history of photosensitivity and facial skin rashes treated by a dermatologist presented with proteinuria and facial skin lesions in a butterfly distribution as shown in the picture. The differential diagnosis consists of:
1. Acute butterfly skin rash of lupus erythematosus  
2. Atrophic skin changes due to local corticosteroid treatment  
3. Chronic lupus erythematosus with a butterfly appearance  
4. Combination of skin lesion due to chronic lupus erythematosus and local treatment with corticosteroids.



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