Batna Journal of Medical Sciences
Volume 13, Numéro 6, Pages 487-492
2026-07-01
Lupus Or Psoriasis? The Blurring Boundary: A Case Report
Authors : Khaldoun Naoual .
Abstract
Psoriasis (Ps) and systemic lupus erythematosus (SLE) are immune-mediated disorders traditionally considered distinct entities with differing immunopathogenic pathways. However, emerging evidence reveals shared genetic susceptibilities and overlapping immune mechanisms, leading to rare but clinically significant co-occurrence syndromes. This overlap poses diagnostic and therapeutic challenges, given the contrasting management approaches for each condition. To present a detailed case of SLE with overlapping psoriatic lesions and review current understanding of shared pathogenesis, clinical presentation, and management strategies. Clinical, laboratory, and sequential histopathologic findings of a 47-year-old woman with a long history of SLE who developed atypical cutaneous lesions suggestive of both lupus and psoriasis were analyzed. A thorough literature review was conducted focusing on genetic predisposition, immunological pathways, and therapeutic options for patients exhibiting features of both diseases. Consent for publication has been obtained from the patient. The patient presented with annular, scaly plaques affecting skin of all her body, scalp, and nails. Laboratory tests confirmed active severe SLE (SLEDAI 22). Sequential skin biopsies revealed histopathological features of both psoriasis and subacute cutaneous lupus erythematosus (SCLE). Escalation of hydroxychloroquine paradoxically worsened the skin eruption, highlighting therapeutic complexity. Shared immunopathogenic mechanisms include activation of the IL-17/Th17 axis, type I interferon signature, innate immune dysregulation, and shared genetic susceptibility loci (PTPN22, STAT4, and TNIP1). Management requires individualized strategies that balance immunosuppressants and biologics, with vigilant monitoring. Although rare, the coexistence of psoriasis and SLE represents a clinically important overlap syndrome with shared immunopathogenic pathways. Enhanced awareness is critical for accurate diagnosis and tailored management.
Keywords
Psoriasis ; Systemic Lupus Erythematosus ; Overlap Syndrome ; Histopathology ; Hydroxychloroquine
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