A Case Series of Amicrobial Pustulosis of Folds: An Eye-opener for the Diagnosis of Autoimmune Disorders
Published: September 1, 2023 | DOI: https://doi.org/10.7860/JCDR/2023/61466.18386
Rajkumar Kannan, Samuel Jeyaraj Daniel, Parimalam Kumar, Akshaya Pradeep Nagalakshmi
1. Professor, Department of Dermatology, Madras Medical College, Chennai, Tamil Nadu, India.
2. Associate Professor, Department of Dermatology, Madras Medical College, Chennai, Tamil Nadu, India.
3. Professor, Department of Dermatology, Madras Medical College, Chennai, Tamil Nadu, India.
4. Resident, Department of Dermatology, Madras Medical College, Chennai, Tamil Nadu, India.
Correspondence
Dr. Akshaya Pradeep Nagalakshmi,
Resident, Department of Dermatology, RGGGH and Madras Medical College, Parktown, P.H. Road, Chennai-600003, Tamil Nadu, India.
E-mail: akshayapn2412@gmail.com
Amicrobial Pustulosis of Folds (APF) is a rare, chronic, relapsing cutaneous disease seen exclusively in younger women with a history of autoimmune disease, most commonly Systemic Lupus Erythematosus (SLE), or who simply have circulating autoantibodies. This case series highlights the occurrence of an unusual manifestation of APF as a marker of autoimmune disorders and emphasises the importance of double-stranded Deoxyribose Nucleic Acid (dsDNA) positivity in such cases. A total of five female patients with APF were included in this case series. All five cases presented with pustular lesions lasting 10-12 weeks, involving conchal bowls, eyes, perineal, and perianal regions, either as an initial presentation or as a flare-up of pre-existing autoimmune disease. All patients underwent screening for autoimmune disorders, which revealed dsDNA positivity and met the diagnostic criteria for APF. Therefore, a diagnosis of APF with SLE was made. All patients showed significant improvement with oral steroids. Although SLE is a complex multisystem disorder where patients may not always present with malar rash, photosensitivity, arthritis, and arthralgia, APF could serve as an eye-opener for diagnosing underlying autoimmune diseases.
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