Cutaneous manifestations of systemic lupus erythematosus in a tertiary referral center

Abstract

Background:Systemic lupus erythematosus (SLE) is an autoimmune disease with multiorgan involvement. The skin is the second most commonly affected organ. SLE with skin lesions can produce considerable morbidity resulting from painful skin lesions, alopecia, disfigurement, etc. Skin lesions in patients with lupus may be specific (LE specific) or may be non specific (LE non specific). Acute cutaneous LE (Lupus specific) has a strong association with systemic disease and non-specific skin lesions always indicate disease activity for which patients present to rheumatologists and internists. Therefore, a thorough understanding of the cutaneous manifestations of SLE is essential for most efficient management.Aims:The aims of this study were to evaluate the patterns and prevalence of skin lesions in patients with SLE and to assess the relationship between skin lesions and other systemic involvement.Materials and Methods:At the Department of Rheumatology and Clinical Immunology, IPGME&R in Kolkata, 150 patients with SLE fulfilling the clinical and laboratory criteria of the American Rheumatology Association (updated 1982) were examined and followed-up for cutaneous manifestations between January 2002 and January 2007.Results:Skin lesions were important clinical features. About 45 patients (30%) presented with skin lesions although all patients had skin lesions during the follow-up period. Skin changes noted were as follows: Lupus specific lesions: malar rash in 120 patients (80%), photosensitive dermatitis in 75 patients (50%), generalized maculopapular rash in 40 patients (26.67%), discoid rash in 30 patients (20%), subacute cutaneous lupus erythematosus (SCLE) in 5 patients (3.34%), lupus profundus in 5 patients (3.34%). The lupus non-specific lesions were non-scarring alopecia in 130 patients (86.67%), oral ulcers in 85 patients (56.67%), vasculitic lesions in 50 patients (33.34%), bullous lesions in 15 patients (10%), Raynaud's phenomenon in 10 patients (6.67%), pyoderma gangrenosum in 2 patients (1.34%), erythema multiforme in 10 patients (6.67%), and nail fold infarcts in 2 patients (1.34%); however, mucosal discoid lupus, lichenoid discoid lupus, livedo reticularis, sclerodactyly, etc. were not detected. Patients having lupus-specific skin lesions e.g., malar rash were associated with systemic involvement, whereas those having lupus non-specific skin lesions were associated with disease flare.Conclusions:Skin lesions in patients with SLE are important disease manifestations and proper understanding is essential for diagnosis and efficient management.

Demographic and clinical characteristics of cutaneous lupus erythematosus at a paediatric dermatology referral centre

“…15,17 Our female:male ratio of 1.5:1 is somewhat lower than the 3.5:1 reported by Lee. 18 Since maternal auto-antibodies typically clear within 6–9 months of age, infants with neonatal LE are not expected to progress to SLE or cutaneous LE in childhood, although predisposition to development of other autoimmune conditions later in life has been reported.…”

“…15 Reports differ as to the prevalence in paediatrics specifically, with some authors reporting higher rates of children with malar rash than adults and others describing lower percentages of 50–74%. 5,9,16 Our study suggests an even lower prevalence, with only 38% of children with SLE having a malar rash; however, not all children with SLE and typical malar erythema would have been referred to dermatology at our institution (and thus did not meet study inclusion criteria).…”

Cutaneous manifestations and systemic correlation in patients with lupus erythematosus and its subsets: a study of 40 cases

“…In SLE, it was 4.5:1 (18 females, four males). These findings were consistent with that of studies done by Parveen et al and Kole et al 6,7 All the four cases of Rowell's syndrome were female. 14:1…”

Important Role of Caregiver in Management of Systemic Lupus Erythematosus on Patient with Mental Retardation

“…Steroids and antimalarials are the standard treatments for the cutaneous manifestations of SLE. 13,14 Slightly brownish pigmentation has been described in oral mucosa of patients with SLE receiving antimalarials. Oral lesions were found in patients with less than 2 years of diagnosis.…”