The butterfly rash of lupus: An example of aposematism?

the most seasoned and savvy clinician views lupus warily, considering it one of the most bewildering diseases in all of medicine. Th is situation should not be a surprise since the manifestations of lupus are dizzying in their variety and exasperating in their subtlety. Furthermore , although lupus has been at the heart of immuno-logy research for decades, investigators have yet to fi gure out its basis. Lupus represents a blatant violation of the most fundamental laws of the immune system. Nevertheless , the disturbances that dangerously turn self into non-self remain totally obscure. Th e image of lupus adds to the confusion, although lupus actually has two competing images. Th ese images, despite their diff erences, represent lupus's trademarks, its 'brand identity' so to speak. Lupus got its name from the wolf; its usual symbol, however, is the butterfl y. I doubt that there are any two species as unlike one another in attitude, color, and emotional resonance as the wolf and the butterfl y. Even if a misnomer, the word schizophrenic rightly describes this fi erce battle of identity. Branding a specifi c disease with the image of a creature comes with its hazards, and eff orts to link a disease with a member of the animal kingdom are, in fact, unusual. Among the few associations that come to mind are icthyosis to describe skin that looks like fi sh scales; leonine facies, the lion-like visage of patients with lepromatous leprosy; and elephantiasis, the thickened skin and bulging extremities from fi lariasis. In another realm, the term cancer stands as a general term for malignancy. Cancer is Latin for 'crab' and is one of the signs of the zodiac. No doubt, some old-time pathologist peering through a microscope thought that tumor cells looked like crazed crustaceans with pincers meant to harm. Th e term crab has another medical meaning since pubic lice are often called crabs. Pubic lice cause a nasty infestation, although the Phthirus pubis insects that besiege the groin really do look like crabs and most certainly bite. Th e full name for lupus – systemic lupus erythema-tosus – is a mélange that roughly translates as a systemic disease in which a wolf turns red. Th e word lupus became part of the name since the lesions in the classic rash allegedly look like the bite or scratch of a wolf. Having never seen the aftermath …