PATCHES AND PLAQUES Annular Rash Neonatal Lupus Neonatal lupus is an autoimmune disorder caused by the passive transfer of maternal autoantibodies, anti-Ro, anti-La, and, less commonly, antiribonucleoprotein (U1-RNP) ( Fig 69.9 ) The skin and heart are commonly affected, with the most serious complication being third-degree atrioventricular heart block, which results in fetal and neonatal mortality rates of 15% to 30% Ten percent of patients experience thrombocytopenia, neutropenia, or anemia, which are usually transient Neonatal lupus can present as annular (ring-like), red, scaly patches, most commonly on the head and neck Rash around the periorbital region should make suspicion very high ( Fig 69.10 ) Neonatal lupus can also manifest as scaly atrophic patches similar to discoid lupus Mucosal erosions have been noted in some infants The diagnosis also has implications for the mother and her future pregnancies Women who have had a child with NLE have an increased risk of having a child with neonatal lupus in subsequent pregnancies Up to 83% of mothers who have an infant diagnosed with NLE are themselves asymptomatic at the time However, approximately 50% of these mothers have or will subsequently develop an autoimmune disorder, commonly Sjogren disease Any annular erythematous rash in a newborn should be assumed to be NLE until definitively proven otherwise