History of Lupus

The history of lupus erythematosus (LE) has been reviewed in both of the major textbooks on this disease [1,2] and was the subject of an article in this journal in 1983.[3] This article concentrates on developments in the present century which have logarithmically expanded our knowledge about the pathophysiology, clinical-laboratory features, and treatment of this disorder.

The history of lupus can be divided into three periods: the classical period which saw the description of the cutaneous disorder, the neoclassical period which saw the description of the systemic or disseminated manifestations of lupus, and the modern period which was heralded by the discovery of the LE cell in 1948 and is characterized by the scientific advances noted above.

Classical Period

The history of lupus during the classical period was reviewed by Smith and Cyr in 1988.[4] Of note are the derivation of the term lupus and the clinical descriptions of the cutaneous lesions of lupus vulgaris, lupus profundus, discoid lupus, and the photosensitive nature of the malar or butterfly rash. The term lupus (Latin for wolf) is attributed to the thirteenth century physician Rogerius who used it to describe erosive facial lesions that were reminiscent of a wolf's bite.[1,3] Classical descriptions of the various dermatologic features of lupus were made by:

• Thomas Bateman, a student of the British dermatologist Robert William, in the early nineteenth century;
• Cazenave, a student of the French dermatologist Laurent Biett, in the mid-nineteenth century; and
• Moriz Kaposi (born Moriz Kohn), student and son-in-law of the Austrian dermatologist Ferdinand von Hebra, in the late nineteenth century.

The lesions now referred to as discoid lupus were described in 1833 by Cazenave under the term erythema centrifugum, while the butterfly distribution of the facial rash was noted by von Hebra in 1846. The first published illustrations of lupus erythematosus were included in von Hebra's text, Atlas of Skin Diseases, published in 1856.

Neoclassical Period

The Neoclassical era of the history of lupus began in 1872 when Kaposi first described the systemic nature of the disorder:

...experience has shown that lupus erythematosus ... may be attended by altogether more severe pathological changes.. and even dangerous constitutional symptoms may be intimately associated with the process in question, and that death may result from conditions which must be considered to arise from the local malady. [5]