Denouement and Discussion
Neonatal Lupus Erythematosus
Skin lesions vary from hypopigmented or erythematous macules to erosions and ulcers of the epidermis. The lesions are often reminiscent of discoid lupus with annular shapes and accentuated borders. Macular lesions tend to show central clearing. The various skin lesions of neonatal lupus erythematosus (LE) may be associated with telangiectasia. Other findings include congenital heart block and thrombocytopenia.Present on skin biopsy specimens are liquefaction degeneration of the basal cell layer, perivascular and perifollicular infiltrates of mononuclear cells, and follicular plugging. Direct immunofluorescence shows deposition of IgG and complement along the basement membrane zone.Laboratory confirmation of neonatal LE includes a positive antinuclear antibody (ANA), elevated antibody titers to DNA, and an elevated ESR. These values are transient. Thrombocytopenia may occur secondary to transplacental platelet antibodies. Recently, precipitating antibodies to cytoplasmic antigens designated SS-A (Ro) were found in the sera of infants (and their mothers) with neonatal LE.