A 29-year-old woman with lupus presents with an itchy, painful Rash on her nose and hands after the weather turned cold. What is the diagnosis?
A 29-year-old woman with a history of systemic lupus erythematosus presented to the dermatology clinic with a 2-week history of an itchy, painful rash on her nose and hands. The rash had first appeared 1 day after the weather had turned cold. The patient reported no sun exposure. The physical examination was notable for erythematosus macules and papules with punched-out ulcers on the nose. Scattered papules were seen on the palms, and edematous erythrocyanosis of the fingertips with ulcerations on the lateral aspects was noted. Blood tests were positive for antinuclear antibodies, anti–double-stranded DNA antibodies, rheumatoid factor, anti-Ro antibodies, and antiphospholipid antibodies, and hypergammaglobulinemia was present. Cryoglobulin and cold agglutinin testing was negative. Histopathological examination of a biopsy specimen of the right nasal sidewall revealed vacuolar interface dermatitis and perivascular lymphocytic infiltrate. Which of the following is an important intervention to prevent this finding?
What is the most likely diagnosis?
Chilblain lupus erythematosus, Cold avoidance, Cold-induced rash, Cutaneous lupus, Systemic Lupus Erythematosus
