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Facial Swelling in Lupus: Mechanisms and Clinical Features
Systemic lupus erythematosus (SLE) causes facial swelling through multiple pathways:
- Inflammation: Immune complex deposition, complement activation → perivascular edema.
- Renal involvement: Lupus nephritis → sodium retention, hypoalbuminemia → periorbital/facial edema (worse mornings).
- Vasculitis: Small vessel inflammation → localized swelling, palpable purpura.
- Malar rash: Erythematous, edematous plaques over cheeks/nasal bridge (photosensitive).
- Medication effects: Corticosteroids → cushingoid facies; NSAIDs → fluid retention.
New or worsening facial swelling in SLE warrants assessment for flare, nephritis, angioedema (C1 esterase inhibitor deficiency), or drug reaction. Urinalysis, creatinine, complement (C3/C4), anti-dsDNA guide management.
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