Lupus erythematosus and the skin (original) (raw)
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Clinical characteristics of cutaneous lupus erythematosus
Advances in Dermatology and Allergology, 2016
Introduction: Lupus erythematosus (LE) shows a wide variety of clinical manifestations, skin involvement being one of the most important. Aim: To analyze the clinical presentation of cutaneous variants of lupus erythematosus in terms of skin lesion spectrum and extracutaneous involvement. Material and methods: A total of 64 patients with cutaneous LE (CLE) were included. The study was based on the "Core Set Questionnaire" developed by the European Society of Cutaneous Lupus Erythematosus (EUSCLE). Clinical severity of skin lesions was evaluated with the Cutaneous Lupus Erythematosus Disease Area and Severity Index (CLASI). All results were subjected to statistical analysis. Results: Fifteen (23.4%) patients had an acute CLE (ACLE), 26 (40.6%) subacute CLE (SCLE) and 21 (32.8%) chronic CLE (CCLE). Two (3.2%) individuals only demonstrated urticarial vasculitis as a cutaneous manifestation of LE and these patients were excluded. Patients with ACLE were characterized by the earliest onset of the disease (mean age of 31.9 ±15.0 years; p < 0.001). On average, 4.8 ±1.8 criteria of systemic LE were found in the ACLE group compared to 2.7 ±1.3 criteria in SCLE and 2.5 ±1.5 criteria in CCLE (p < 0.001). The highest activity of skin lesions according to CLASI was found in the SCLE group (p = 0.002). On the other hand, the most severe skin damage was observed in CCLE (p < 0.01). Conclusions: Each variant of CLE differs significantly from the others in respect of various aspects of clinical manifestations. Due to a number of different variants of LE skin lesions, a unified classification of CLE still remains a challenge.
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, 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.
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.
Cutaneous Lupus Erythematosus in India: Immunofluorescence Profile
International Journal of Dermatology, 1992
The clinical profile and cutaneous lesions of 65 patients with lupus erythematosus (LE) are described. This included 28 discoid LE (13 disseminated, 15 localized), five subacute cutaneous LE, and 32 systemic LE. The need to recognize a pigmented macular form constituting 25% of discoid LE is emphasized. Increased incidence of involvement of the lower lip in discoid LE and pigmentation in systemic LE is noted. Lupus band test was found to be highly sensitive; it was positive for lesional skin of all untreated patients with subacute cutaneous LE and systemic LE, it was, however, not useful on nonlesional skin. A wide variety of cutaneous lesions are seen in lupus erythematosus (LE); they are classified into several morphologic types. These lesions have well defined clinical and histopathologic features that are more or less pathognomonic. Lupus band test (LBT) by immunofluorescence in patients with LE has gained importance both for diagnosis and prognosis of the disease.'-' Due to prohibitive cost or lack of technical expertise LBT has not been used widely in the diagnosis of LE in India. This paper describes tbe clinical profile of patients with cutaneous LE in a tertiary care hospital in India and discusses the role of LBT as a diagnostic and prognostic tool in tbese patients. The findings are compared with those reported from other centers. Materials and Methods All patients attending the dermatology clinic during June 1987 to June 1990 with clinical features suggestive of LE were studied. The diagnosis of discoid LE (DLE) was based on clinical features. Patients who had symmetric, widespread, superficial, and nonscarring forms of cutaneous LE with mild systemic symptoms were diagnosed to have subacute cutaneous LE (SCLE). The diagnosis of systemic lupus erythematosus (SLE) was based on American Rheumatic Association criteria.*' All patients suspected of having SCLE and SLE underwent laboratory investigations, which included hemogram, urine microscopic examination, urine albumin, serum creatinine, 24 hour urine protein, LE cells, antinuclear
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.
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.
Autoimmunity Reviews, 2013
In this prospective, cross-sectional, multicenter study, we assessed clinical and laboratory characteristics from patients with cutaneous lupus erythematosus (CLE) using the Core Set Questionnaire of the European Society of Cutaneous Lupus Erythematosus (EUSCLE). 1002 (768 females, 234 males) patients with different subtypes of CLE, such as acute CLE (ACLE, 304 patients), subacute CLE (SCLE, 236 patients), chronic CLE (CCLE, 397 patients), and intermittent CLE (ICLE, 65 patients), from 13 European countries were collected and statistically analyzed by an SPSS database. The main outcome measures included gender, age at onset of disease, LEspecific and LE-nonspecific skin lesions, photosensitivity, laboratory features, and the criteria of the American College of Rheumatology (ACR) for the classification of systemic lupus erythematosus. The mean age at onset of disease was 43.0± 15.7 years and differed significantly between the CLE subtypes. In 347 (34.6%) of the 1002 patients, two or more CLE subtypes were diagnosed during the course of the disease and 453 (45.2%) presented with LE-nonspecific manifestations. Drug-induced CLE and Sjögren´s Syndrome had the highest prevalence in SCLE patients (13.1% and 14.0%, respectively). Photosensitivity was significantly more frequent in patients with ACLE, SCLE, and ICLE compared with those with CCLE. The detection of antinuclear antibodies such as anti-Ro/SSA and anti-La/SSB antibodies revealed further significant differences between the CLE subtypes. In summary, the EUSCLE Core Set Questionnaire and its database facilitate the analysis of clinical and laboratory features in a high number of patients with CLE and will contribute to standardized assessment and monitoring of the disease in Europe.