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Primary anetoderma: a cutaneous sign of antiphospholipid antibodies

Department of Dermatology, Rabin Medical Center, Beilinson Campus, Petah Tiqva, Israel, ehodak{at}clalit.org.il

H Feuerman

Department of Dermatology, Rabin Medical Center, Beilinson Campus, Petah Tiqva, Israel

Y Molad

Rheumatology Unit, Rabin Medical Center, Beilinson Campus, Petah Tiqva, Israel

Y Monselise

Laboratory of Clinical Immunology, Rabin Medical Center, Beilinson Campus, Petah Tiqva, Israel, and the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel

M David

Department of Dermatology, Rabin Medical Center, Beilinson Campus, Petah Tiqva, Israel

Although a few reports in recent years have suggested that patients with antiphospholipid antibodies (aPL) are proneto developingprimaryanetoderma(PA), it is still unclearhowoften aPL are detectedin unselected PA patients. We studied nine consecutive PA patients for the presence of autoimmune antibodies and disorders in general and the presence of aPL in particular. Six of the nine patients had clinical evidence of associated autoimmune disorders (Graves’disease and autoimmune haemolysis in one, systemic scleroderma in one, Hashimoto’s thyroiditisin one, alopecia areata in one) and/or signs of hypercoagulability (recurrent fetal loss in two, recurrent strokes in one, recurrent deep vein thrombosis in one). In four of these six patients the onset of PA preceded these signs. Positive aPL was foundin all: anticardiolipin(aCL) in six, anti-ß₂-glycoprotein-I(aß₂ GPI) in six and lupusanticoagulant (LAC) in four. The most frequent isotype was IgA. Among other autoantibodies found the most frequentlywas antinuclearantibodies.Four of theninepatientsfulfilled thecriteriaforantiphospholipid syndrome (APS). It is concluded that PA is an important cutaneous sign for autoimmune disorders in general and the presence of aPL in particular. Hence, the work-up of these patients should include testingfor LAC as well as forall differentisotypesof aCL andaß₂ GPI. We recommendthat PA be added to the list of the cutaneous manifestations of APS.

Key Words: anti-ß2-glycoprotein-I antibodies • anticardiolipin antibodies • antiphospholipid syndrome • lupus anticoagulant • primary anetoderma

Lupus, Vol. 12, No. 7, 564-568 (2003)
DOI: 10.1191/0961203303lu403oa


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