Introduction Lupus erythematosus (LE) is a multisys- tem disorder with a spectrum from a rela- tively benign, self-limited cutaneous erup- tion to a severe, often fatal, systemic disease. The American Rheumatism Association (ARA) has developed a set of criteria that can be used for the differentiation of cuta- neous subtypes from systemic lupus ertythe- matosus (SLE) (1). When a patient has four or more of the criteria either concurrently or serially during any period of observation, the patient can be classified as SLE. In the 1940s and 1950s, dermatologists recognized a subset with transient skin lesions that did not result in scarring or atrophy; these pa- tients had systemic disease, but their prog- nosis was not as poor as that of patients with SLE. Various names have been given to this subset, but that proposed by Sontheimer and Gilliam, subacute cutaneous lupus ery- thematosus (SCLE), is the most widely ac- cepted (1, 2). SCLE is a type of LE-specific skin lesion characterized by papulo-squa- mous and/ or annular, polycyclic non scar- ring lesions distributed in both sun-exposed and sun-protected areas, usually above the waist and particularly around the neck, on the back and front of the trunk, and on the outer aspects of the arms (2, 3). Idiopathic thrombocytopenic purpura (ITP) is mediat- ed by a destructive immunoglobulin (Ig) G antibody response to the platelets’ mem- brane components (4). In 1960, Rabinowitz and Dameshek emphasized the close rela- tionship between ITP and SLE and suggest- ed that ITP might precede SLE (5). A re- cent report revealed that the cases of SCLE Received September 21, 2004; accepted for publi- cation April 6, 2005. Departments of Dermatology, *Pathology, Ege University Medical Faculty, Bornova-Izmir, Turkey. Reprint requests to: Bengü Gerceker Turk, M.D., Ege University Medical Faculty, Department of Der- matology, 35100 Bornova-Izmir, Turkey. The Journal of Dermatology Vol. 32: 727–730, 2005 ITP as an Initial Manifestation of Subacute Cutaneous Lupus Erythematosus Idil Unal, Can Ceylan, Fezal Ozdemir, Bengü Gerceker Turk, Ali Can Kazandi and Gulsen Kandiloglu* Abstract Subacute cutaneous lupus erythematosus (SCLE) is an entity characterized by wide- spread polycyclic lesions that heal without scarring. Skin lesions with marked ultraviolet sensitivity are distributed in an annular and/ or psoriasiform configuration. Idiopathic thrombocytopenic purpura, which is an autoimmune disease (ITP), is mediated by a de- structive immunoglobulin G antibody response to the platelets’ membrane components. We report a case of subacute cutaneous lupus erythematosus initially manifested as throm- bocytopenia, which was diagnosed as idiopathic thrombocytopenic purpura (ITP) and treated with splenectomy. Seven months later, development of cutaneous involvement fol- lowed the diagnosis of ITP. The clinical and histological features of the lesions were com- patible with SCLE. Serological evaluations showed a negative anti-nuclear antibody test and an elevated anti-SSB/ La antibody level. Symptoms for systemic involvement were neg- ative. Although the clinical features such as photosensitivity, discoid rash, and thrombocy- topenia were in favor of SLE, the patient did not fulfill the criteria of the American Rheumatism Association (ARA) for SLE. Key words: SLE; SCLE; idiopathic thrombocytopenic purpura