Clinicohistological and immunopathological features of patients with cutaneous lupus erythematosus at tertiary dermatology centre in Malaysia

Abstract

Background Cutaneous lupus erythematosus (CLE) is a chronic, autoimmune skin disease with a wide spectrum of clinical presentations in different populations. Aim To study the clinicohistological and immunological features of CLE in a multiethnic population and to identify the predictive factors of disease severity based on the Cutaneous Lupus Erythematosus Disease Area and Severity Index (CLASI). Methods This was a cross‐sectional study of CLE conducted from March 2019 to February 2020. Results In total, 111 patients were recruited with a female/male ratio of 4.9 : 1. Acute CLE contributed 47.7%, followed by chronic CLE at 46.9% and subacute CLE at 5.4%. A large majority (84%) of patients had systemic lupus erythematosus. Of patients with chronic CLE, about 67.3% developed systemic involvement. Antinuclear antibody (ANA) was detected in 90.0%. Skin biopsy was taken from 42 patients and showed perivascular lymphocytic infiltration (95.2%), epidermal atrophy (47.6%) and hydropic degeneration of the basal layer (47.6%). Immunoglobulin deposition at the dermoepidermal junction was seen in > 40% of patients, predominantly in a granular pattern. Mean CLASI Total was 6.44 ± 7.70, while CLASI Activity (CLASI‐A) was 2.75 ± 4.10 and CLASI Damage (CLASI‐D) was 3.71 ± 4.76. Involved body surface area (BSA) was found to be an independent predictive factor for CLASI‐A (OR = 1.34, P < 0.02). For CLASI‐D, positive predictive factors were involved BSA (OR = 4.14, P < 0.001), discoid lupus erythematosus subtype (OR = 13.10, P = 0.001), cutaneous vascular disease (OR = 26.59; P = 0.014), scalp involvement (OR = 8.7, P < 0.01) and hypocomplementaemia (OR = 5.71, P < 0.5). Mean Dermatology Life Quality Index was 5.91 ± 5.34 and correlated significantly with disease severity. Conclusions We observed a high percentage of patients with CLE with systemic manifestations and positive ANA result. More aggressive treatment of patients with positive predictive factors for severe disease combined with significant clinical activity may be warranted.

Dermoscopic Characteristics of Cutaneous Lupus Erythematosus According to Subtype, Lesion Location, Lesion Duration, and CLASI Score

“…The sociodemographic characteristics of our study sample (age, sex, age at onset) were similar to those in other studies [ 7 ]. Fredeau et al reported that 73% of patients had a Fitzpatrick skin type between I and IV [ 21 ].…”

“…CLASI-A scores were grouped into disease activity levels of mild (0-9), moderate (10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20), and severe (21-70) as recommended by Klein et al [16]. CLASI-D scores were grouped into disease severity levels of mild (0-5), moderate (6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16), and severe (≥17) [17].…”

“…DLE heals with scarring and dyspigmentation, and severe inflammatory DLE impacts patients’ quality of life [ 5 – 7 ]. The differential diagnosis of DLE includes many diseases, and early treatment leads to complete clearance of active lesions [ 8 , 9 ].…”

“…The differential diagnosis of DLE includes many diseases, and early treatment leads to complete clearance of active lesions [ 8 , 9 ]. For patients with CLE, using the CLE Disease Area and Severity Index (CLASI) is recommended at baseline, while monitoring treatment response, and in the assessment of the disease impact on quality of life [ 7 , 8 ]. CLASI is used in most CLE patients, with the exception of a few rare subtypes [ 10 ].…”

“…Lupus erythematosus tumidus (LET), the most photosensitive type of lupus erythematosus, was recently classified separately as intermittent CLE (ICLE) [4]. DLE heals with scarring and dyspigmentation, and severe inflammatory DLE impacts patients' quality of life [5][6][7]. The differential diagnosis of DLE includes many diseases, and early treatment leads to complete clearance of active lesions [8,9].…”