No abstract

Our findings underscore striking racial disparities in the susceptibility for primary CCLE, with black people experiencing between three and five-fold increased incidence of CCLE in general and DLE in particular, compared to white people. Gender differences were consistent with those reported previously, with a three times higher risk of DLE in females compared to males. This article is protected by copyright. All rights reserved.

Objective: Depression may occur in up to 30% of individuals with cutaneous lupus erythematosus (CLE), many of whom may also have systemic manifestations. Compared to acute and subacute, chronic cutaneous lupus erythematosus (CCLE) conditions are less likely to present systemic involvement, but more often cause permanent scarirng and dyspigmentation. Little is known, however, about depression in those who have CCLE confined to the skin (primary CCLE). As African Americans are at high risk for primary CCLE and depression, we aimed to investigate the prevalence and explore risk factors of depression in a predominantly Black population-based cohort of patients with primary CCLE.Methods: Cross-sectional analysis of a cohort of individuals with a documented diagnosis of primary CCLE, which is established in the metropolitan Atlanta. Participants were recruited from the Centers for Disease Control and Prevention (CDC) population-based Georgia Lupus Registry, multi-center dermatology clinics, community practices, and self-referrals. The Patient Reported Outcomes Measurement Information System (PROMIS) was used to measure the primary outcome: depressive symptoms. Stand-alone questions were used to assess sociodemographics and healthcare utilization. Emotional, informational, and instrumental support were measured with PROMIS short forms, interpersonal processes of care with the IPC-29 Survey, and skin-related quality of life with the Skindex-29+ tool.Results: Of 106 patients, 92 (86.8%) were female, 91 (85.8%) Black, and 45 (42.9%) unemployed or disabled. Twenty-eight (26.4%) reported moderate to severe depressive symptoms. Depression severity was lower in patients aged ≥60, married, or college-graduated. Univariate analysis showed that being employed (OR=0.24, 95% Confidence Interval (CI)=0.10-0.61),

ObjectiveWhile the contribution of B-cells to SLE is well established, its role in chronic cutaneous lupus erythematosus (CCLE) remains unclear. Here, we compare B-cell and serum auto-antibody profiles between patients with systemic lupus erythematosus (SLE), CCLE, and overlap conditions.MethodsB-cells were compared by flow cytometry amongst healthy controls, CCLE without systemic lupus (CCLE+/SLE−) and SLE patients with (SLE+/CCLE+) or without CCLE (SLE+/CCLE−). Serum was analyed for autoreactive 9G4+, anti-double-stranded DNA, anti-chromatin and anti-RNA antibodies by ELISA and for anti-RNA binding proteins (RBP) by luciferase immunoprecipitation.ResultsPatients with CCLE+/SLE− share B-cell abnormalities with SLE including decreased unswitched memory and increased effector B-cells albeit at a lower level than SLE patients. Similarly, both SLE and CCLE+/SLE- patients have elevated 9G4+ IgG autoantibodies despite lower levels of anti-nucleic acid and anti-RBP antibodies in CCLE+/SLE−. CCLE+/SLE− patients could be stratified into those with SLE-like B-cell profiles and a separate group with normal B-cell profiles. The former group was more serologically active and more likely to have disseminated skin lesions.ConclusionCCLE displays perturbations in B-cell homeostasis and partial B-cell tolerance breakdown. Our study demonstrates that this entity is immunologically heterogeneous and includes a disease segment whose B-cell compartment resembles SLE and is clinically associated with enhanced serological activity and more extensive skin disease. This picture suggests that SLE-like B-cell changes in primary CCLE may help identify patients at risk for subsequent development of SLE. B-cell profiling in CCLE might also indentify candidates who would benefit from B-cell targeted therapies.

Dermatologic surgeons vary widely on practices of photo storage and opinions of identifiability. Dermatology as a specialty may consider generating a consensus statement on appropriate use and storage of digital photography in dermatology practice.