Renowned Author Jean Bolognia, MD, Draws on Stellar Career to Educate DermPAs™
Bolognia peels back the layers on lupus as she fields question the from attendees
SDPA President Renata Block, MMA, PA-C, welcomed attendees to the SDPA Annual Summer Dermatology Conference with a friendly “howdy” while thanking the exhibitors, sponsors, and staff. She encouraged all attendees to consider their role as a volunteer for service to SDPA and the DermPA™ profession. Ms. Block introduced the highly esteemed keynote speaker Jean Bolognia, MD, for her lecture; “The many faces of lupus.”
COVERAGE: SDPA Annual Summer Dermatology Conference, June 16-19, 2022, Austin, Texas
Dr. Bolognia, a Yale University professor and senior editor of Dermatology Essentials, initiated her presentation by echoing encouragement for all attendees to consider volunteerism to the profession in any way possible, however small, or as she stated, “get out of the cheap seats!”. After reviewing the origination of the EULAR/ACR and SLICC (2012 ) diagnostic criteria for lupus, Dr. Bolognia warned a “positive ANA does not lupus make,” noting patients who have rosacea, depression, and osteoarthritis may have a positive ANA, but they may not have lupus. It may fall to our role as providers to be the first to explain this to a patient presenting with a positive ANA.
Next, Dr. Bolognia reported one of the differentiating symptoms of acute lupus from other conditions is that lupus patients tend to be ill with additional constitutional symptoms—these patients may have fevers, feel unwell, have hair loss and/or look sick. The typical malar rash of acute lupus is pink to violaceous (purple-pink) with nasolabial sparing and is a rash with well demarcated borders (i.e., does not fade into the background). One pearl shared is that patients might not realize that SLE lesions move. To aid and diagnosis, have the patient circle the lesion, take a picture, wait 24 hours, and then take a second picture. Likely, the second picture will reveal that the lesions have moved. Another tip for differentiating the rash of urticarial vasculitis from lupus is the rash of lupus does not fade within 24 hours. Furthermore, the bullous eruption of SLE was illustrated with patient presentations. Again Dr. Bolognia reiterated the systemic acute inflammatory disease causes patients to feel poorly. She noted that when neutrophils are present, it may be appropriate to prescribe dapsone.
The next part of her discussion focused on differences in the presentation of the acute rash of lupus and dermatomyositis. When diagnosing subacute lupus, Dr. Bolognia reports this rash should reliably be found on the upper outer arms and trunk. The rash of sub-acute lupus in adults may spare the face. When babies present with sub-acute lupus, however, their rash presentation may be confined to the head and neck. Timing of patient presentation may be a clue to diagnosing drug-induced SCLE. For example, patients who live in northern latitudes may not present with lupus until they travel down south or to a sunny climate because the condition requires both light exposure and the medication for the response to occur. Additional teaching from Dr. Bolognia included the overview of hypertrophic presentations of lupus, vascular manifestations, and the presentation of lupus in children.
Byline: Sarah B.W. Patton, PA-C
Pictured: Jean Bolognia, MD