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time and in the absence of drugs known to be associated with “drug-induced lupus” syndrome Low complement laboratory reference range Presence of antibody to Sm nuclear antigen Antiphospholipid antibody positive, by any of the following: Lupus anticoagulant; false-positive RPR; medium or high titer anticardiolipin (IgA, IgG, or IgM); or positive test result for anti–beta-2 glycoprotein I (IgA, IgG, or IgM) Low C3; low C4; or low CH50 Direct Coombs test Direct Coombs test in the absence of hemolytic anemia Although the new criteria and definitions were intended as classification symptoms to be used for research, they are often used by clinicians to establish a diagnosis Nonetheless, patients may have SLE and not fulfill criteria, or they may meet criteria despite having another illness The SLICC criteria begin with four separate dermatologic manifestations and differentiates acute from chronic lesions Acute cutaneous lupus includes the typical malar erythematous rash with butterfly distribution and sparing of the nasolabial folds, as well as photosensitivity and bullous lupus Chronic cutaneous lupus includes classical discoid lesions, both localized and generalized ( Fig 101.1 ) Mucosal lesions (macular and ulcerative) may involve the nose or the mouth, particularly the palate ( Fig 101.2 ) and are usually painless Nonscarring alopecia in the absence of other causes such as alopecia areata, drugs, and iron deficiency is now its own separate criterion The arthritis criteria include joint-line tenderness with 30 minutes of morning