DIAGNOSTIC EVALUATION OF THE LUPUS BAND TEST IN DISCOID AND SYSTEMIC LUPUS ERYTHEMATOSUS (original) (raw)
Arthritis & Rheumatism, 2008
Methods. Fourteen subjects with cutaneous lupus erythematosus (CLE; n ؍ 10), a mimicker skin disease only (a cutaneous lesion that may appear clinically similar to CLE; n ؍ 1), or both (n ؍ 3) were rated with the CLASI by academic-based dermatologists (n ؍ 5) and rheumatologists (n ؍ 5). Results. The dermatology intraclass correlation coefficient (ICC) was 0.92 for activity and 0.82 for damage; for rheumatology the ICC was 0.83 for activity and 0.86 for damage. For intrarater reliability, the dermatology Spearman's rho was 0.94 for activity and 0.97 for damage; for rheumatology the Spearman's rho was 0.91 for activity and 0.99 for damage.
https://www.ijrrjournal.com/IJRR\_Vol.6\_Issue.7\_July2019/Abstract\_IJRR002.html, 2019
Lupus erythematosus (LE) is a multisystem disease with a broad range of clinical manifestations ranging from an isolated cutaneous eruption at one end to a fatal systemic illness at the other. Cutaneous lupus erythematosus may be subdivided into acute, subacute, or chronic based upon the constellation of clinical, histologic, and immunofluorescence findings. Definitive diagnosis prior to treatment initiation is essential as it is a chronic relapsing disease requiring regular-follow-up. Aims: The objectives of this study are to define and characterize the spectrum of histopathological changes in cutaneous lupus erythematosus and to correlate the clinical findings such as lesion size, site and morphology with its histology and to differentiate from other simulating lesions. Methods: It is a cross-sectional observational study at post graduate medical college done for the period of eighteen months. Prior ethical approval was taken from institutional ethical committee. Cases were referred from Dermatology OPD of clinically diagnosed cutaneous LE. Detailed history and physical findings were noted. Each case was diagnosed by histopathological examination and confirmed by Lupus band test in selected cases. Descriptive statistics was done using Microsoft excel. Results: A total of 48 cases were clinically diagnosed as cutaneous lupus erythematosus, 13 male and 35 female. Age of presentation ranged from 5 years to 67 years. Among various subtypes; chronic cutaneous LE (CCLE) was the most frequent subtype most of which presented as discoid lesions. The comparative distribution of histopathological features of the CLE cases, on the basis of which, the lesions are sub classified into ACLE, SCLE and CCLE, along with clinical correlation, were tabulated. Conclusion: Histopathological examination is indispensable in the diagnosis of LE. The commonest histological feature clinching the diagnosis in our study was interface dermatitis with vacuolar degeneration of the basal keratinocytes and perivascular and periadnexal lymphocytic infiltrate.
Journal of Investigative Dermatology, 1992
Subacute cutaneous lupus erythematosus (SCLE) was originally described and distinguished from discoid lupus ery-th~matosus (OLE) on the basis of clinical examination of the shn, but subsequent reports have questioned the concept of SCLE as a marker of a unique subset of LE patients. We classified 27 lupus patients, on the basis of cutaneous exam, as having discoid lupus skin lesions, subacute cutane- skin lesions, or systemic lupus erythematosus (SLE) Without OLE or SCLE lesions. Clinical features most charac-~eristic of SCLE rather than OLE were supe~fi.cial, fo1on-in-u~ated, non-scarring lesions, and photosenSitivIty, With lack ff l.nduration being the single most helpful fin~ing. Histooglc examination oflesional skin showed a relatively sparse, ~perficial infiltrate in SCLE and a denser, deeper infiltrate in fl LE. A distinctive pattern of staining with direc~ i.mmunot uores.cence, particulate epidermal IgG depOSitIOn, w~s
The significance of a positive cutaneous immunofluorescence test in systemic lupus erythematosus
British Journal of Dermatology, 1975
Direct cutaneous immunofluorescence microscopical examination of uninvolved skin is an important diagnostic test in systemic lupus erythematosus. Its prognostic signiflcance is undetermined. In twenty-four patients there was an increased incidence of leukopenia, hypocomplementaemia, and LE cells in patients with positive skin immunofluorescence. Positive cutaneous immunofluorescence of uninvolved skin was correlated with the most severe forms of lupus renal disease, membranous glomerulonephritis, and diffuse proliferative glomerulonephritis. Systemic lupus erythematosus (SLE) is a chronic multisystem disease. Laboratory abnormalities include LE cell phenomena, antinuclear antibodies (ANA), elevated erythrocyte sedimentation rate, leukopenia, abnormal urinalysis, rheumatoid factor, biological false positive serology (VDRL), and decreased serum complement levels . Numerous auto-antibodies, including those against DNA (Holman, i960), RNA (Schur et al., 1971), leukocytes, lymphocytes (Terasaki et al., 1970), erythrocytes, platelets, histone, nucleoprotein, extractable nuclear antigen, ribosomes (Sturgill & Preble, 1967), and lysosomes (Bell et al., 1971) have also been described. In 1963, Burnham et al. reported immunoglobulins and complement at the dermo-epidermal junction in patients with lupus erythematosus. Numerous investigators have conflrmed this and homogeneous, granular and thready patterns of immunofluorescence have been described (Cormane
Cutaneous lupus erythematosus — A study of clinical and laboratory prognostic factors in 65 patients
Irish Journal of Medical Science, 1995
An eleven year review of patients presenting with cutaneous lupus erythematosus (LE) was made in order to determine the frequency of change from discoid LE (DLE) to systemic LE (SLE) and to identify clinical and laboratory prognostic factors. Three of fifty-six (5.4%) patients with DLE progressed to SLE after 1, 13 and 34 years respectively. They had a progressive rash and persistent abnormalities in their full blood count, erythrocyte sedimentation rate, antinuclear antibody and serum immunoglobulins prior to the development of SLE. We recommend that regular longterm monitoring of these indices should be carried out in patients presenting with DLE.
Clinicopathological characteristics of cutaneous lupus erythematosus patients in Bangladesh
Advances in Dermatology and Allergology
Introduction: Nearly all epidemiologic studies have involved patients with systemic lupus erythematosus (SLE). Few authors have investigated the characteristics of patients with cutaneous lupus erythematosus (CLE). Aim: To describe the clinical and pathologic characteristics of a series of patients diagnosed with CLE. Material and methods: This is a descriptive retrospective cross-sectional study carried out using the consecutive registered records of 218 patients attending the 'Lupus Clinic' in Chittagong Medical College Hospital during the period between 2010 and 2020. The activity and damage of CLE were assessed according to the Cutaneous Lupus Erythematosus Disease Area and Severity Index (CLASI). Results: There were 187 (85.8%) females and 31 (14.2%) males, with the female:male ratio being 6 : 1. The mean age was 30.0 ±11.7 years. The chronic cutaneous lupus erythematosus (CCLE) patients numbered 154 (70.6%), followed by acute cutaneous lupus erythematosus (ACLE) n = 46 (21.1%), and subacute cutaneous lupus erythematosus (SCLE) n = 18 (8.3%). In LE-specific skin lesions, the most common manifestation was photosensitivity, 198 (90.8%), followed by discoid rash, 155 (71.1%) and maculo-papular lupus rash, 55 (25.2%). Among LE-nonspecific skin lesions, the most common manifestation was non-scarring alopecia, 123 (56.4%), followed by livedo reticularis, 18 (8.3%), Raynaud's phenomenon, 17 (7.8%), vasculitis, 15 (6.9%), periungual telangiectasia, 7 (3.2%), erythema multiforme, 6 (2.7%) and leg ulcers, 5 (2.3%). Antinuclear antibodies (ANA) were the most common type of autoantibody (n = 132, 60.5%) followed by anti-ds DNA (n = 91, 41.7%) and anti-phospholipid antibodies (n = 9, 4.1%). Conclusions: CCLE was the most common subtypes of CLE. Photosensitivity was the most common clinical manifestation, whereas ANA were the most frequent autoantibodies of the LE patients of this region. Patients with different subtypes of CLE have distinct clinical and pathological characteristics.
Dermatology practical & conceptual, 2024
Dermoscopic findings are used to diagnose and evaluate disease activity in patients with cutaneous lupus erythematosus (CLE). Objectives: This study aimed to characterize the dermoscopic features of discoid LE (DLE) and LE tumidus (LET) by lesion duration and CLE Disease Area and Severity Index (CLASI) scores and to examine the dermoscopic findings of lesions in different locations in DLE patients. Methods: Dermoscopic findings (follicular features, perifollicular surface, interfollicular features, and vessel pattern) were assessed and lesion duration (≤12 and >12 months) and CLASI scores (grouped as mild or moderate) were calculated. DLE lesion locations were categorized as, non-scalp, scalp and lip. Results: Forty-eight dermoscopic images from 35 DLE and 4 LET patients were analyzed. The most common dermoscopic findings in non-scalp DLE were follicular keratotic plugs (82.8%) and white scales (69%). In scalp DLE (n=9), the most common findings were absent follicular openings (77.8%), white structureless areas (77.8%), and perifollicular scaling (66.7%). All LET patients had pink-white background and linear vessels. Follicular plugs, peripheral pigmentation, and polymorphous vessels were lower in patients with mild CLASI activity than moderate activity (P = 0.036, 0.039, and 0.019, respectively). Fibrotic white dots, honeycomb pigment pattern, and blue-gray dots/globules were lower in those with mild CLASI damage scores than moderate damage (P = 0.010, 0.010, and 0.020, respectively). Peripheral pigmentation was more common in patients with lesion duration ≤12 months, while blue-gray dots/globules were more common with lesion durations >12 months. Conclusions: Certain dermoscopic features may facilitate the differential diagnosis of DLE and LET.
Cutaneous Lupus Erythematosus: Comparison of Direct Immunofluorescence Findings With Histopathology
International Journal of Dermatology, 1995
Background. Direct immunofluorescence (DIF) is considered to be a major advance in the diagnosis of connective tissue diseases, particularly lupus erythematosus (LE); however, the reliability of the technique depends on several factors, such as age and site of the lesion, type of immunofluorescence, type of immunoglobulin, etc. False positives and false negatives can occur.
Response criteria for cutaneous SLE in clincal trials
2007
Systemic lupus erythematosus (SLE) is a complex phenotype characterized by a wide variety of clinical manifestations but the skin is involved in 70-80% of patients. Acute cutaneous lupus erythematosus lesions, like other organ manifestations of SLE wax and wane with other manifestations of active disease and quantifying it is a useful a "signal" to screen new therapies in SLE and pre-and post-treatment biopsies can be additionally informative. The ACR has recommended a priori response criteria for SLE Activity Measures (2) and that these be used along with organ specifi c response criteria in clinical trials. We review the literature on evaluation of skin manifestations in lupus erythematosus (LE) and propose the parameters of evaluating responsiveness and criteria for minimal clinically important changes in skin manifestations. The Committee presents two options for grading skin manifestations. These recommendations add to the tools of SLE trials.
Dermatology, 2021
Lupus erythematosus (LE) is an autoimmune disease with a wide range of clinical and cutaneous manifestations. Along with the well-known typical cutaneous manifestations of LE, some cutaneous manifestations are rarer, but still characteristic, enabling the dermatologist and the general practitioner who know them to suspect cutaneous LE (CLE) and investigate a possible underlying systemic involvement. Indeed, not infrequently a skin manifestation is the first presentation of systemic LE (SLE), and >75% of SLE patients show signs of skin disease during the course of the illness. Especially, SLE involvement occurs in cases of acute CLE, while it is uncommon in subacute CLE and rare in chronic CLE. This review aims to concentrate especially on atypical cutaneous manifestations of LE to enable the clinician to diagnose even the rarest forms of CLE.