Pathophysiology of Cutaneous Lupus Erythematosus

Lin, Julie; Dutz, Jan P.; Sontheimer, Richard D.; Werth, Victoria P.

doi:10.1007/s12016-007-0031-x

Cited by 102 publications

(103 citation statements)

References 243 publications

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“…There are limited data on whether CLE affects cancer risk. As the pathogenesis of CLE is similar to SLE, with complex geneenvironment interactions, autoimmunity and immune-mediated cutaneous damage, it is conceivable that patients with CLE may be at increased risk for cancer [8]. At the same time, the limited extent of organ involvement with absence of systemic damage suggests that chronic systemic inflammation may be absent in patients with CLE [9].…”

Section: Introductionmentioning

confidence: 99%

Cancer risk in cutaneous lupus erythematosus: a population-based cohort study

Singh¹,

Crowson²,

Singh³

et al. 2016

Rheumatology

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Objective. Immune dysregulation associated with chronic autoimmune diseases, such as SLE, has been associated with increased cancer risk. It is unclear whether isolated cutaneous lupus erythematosus (CLE) modifies cancer risk. We estimated the cumulative incidence of cancer in a population-based CLE cohort and compared the risk with a matched non-CLE cohort.Methods. All incident cases of CLE in Olmsted County, MN, USA between 1965 and 2005 were identified and followed to December 2013. Estimates for the cumulative incidence of any cancer and skin cancer in patients with CLE were derived and compared with an age-, sex-and calendar-year-matched non-CLE cohort using Cox models.Results. There were a total of 155 patients with CLE [age at diagnosis, 48 (S.D. 16) years; 65% females; BMI, 26.3 (S.D. 7.1) kg/m 2 ; 40% smokers, 9% with diabetes]. During a median follow-up of 14.6 years, we observed 35 cases of incident cancer (including 10 cases of skin cancer). The cumulative 1-, 5-and 10-year incidence of any cancer after diagnosis of CLE was 1.4, 7.5 and 11.6%, respectively. Compared with matched non-CLE controls, the overall risk of malignancies was not increased in patients with CLE (smoking-adjusted hazard ratio = 1.29; 95% CI: 0.78, 2.13; P = 0.31). There was also no significant increase in risk of any skin cancer in patients with CLE (hazard ratio = 2.51; 95% CI: 0.91, 6.96; P = 0.16).Conclusion. CLE is not associated with an increased risk of any cancers, including skin cancers, compared with the general population. However, the number of events was small, limiting the power of the study.

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Section: Introductionmentioning

confidence: 99%

Cancer risk in cutaneous lupus erythematosus: a population-based cohort study

Singh¹,

Crowson²,

Singh³

et al. 2016

Rheumatology

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“…The psoriasiform lesions of SCLE were not evident clinically and histologically in this patient as it might have occurred interlacedly with psoriatic plaques, hence upon healing, left non scarring pigmented changes seen at the time of the biopsy [1]. Psoriasis and cutaneous lupus are easily differentiated if they occur in their typical forms.…”

Section: Discussionmentioning

confidence: 67%

“…Given the strong association with anti-Ro/SS-A antibody [1,2], subacute cutaneous lupus erythematosus (SCLE) is suspected to be the most likely underlying lupus that remained dormant and smouldering until it was triggered by the use of adalimumab and phototherapy [3]. A large proportion of SCLE (up to 50%) do not fulfill the American College of Rheumatology criteria [2,4,5].…”

Section: Discussionmentioning

confidence: 99%

Hibernating Lupus

Suzuki¹,

Lateef²

2015

Rheumatology (Sunnyvale)

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We report a case of a 64-year-old Chinese lady, who was admitted for two weeks' history of fever, cough and breathlessness. She was diagnosed with community acquired pneumonia and treated with antibiotics. Her comorbidity includes plaque psoriasis treated with topical steroids and oral methotrexate for 4 years by private physicians. Her symptoms persisted for weeks post-discharge. After workup, a diagnosis of basal interstitial lung disease with restrictive defect likely drug-induced was established. Her methotrexate therapy was switched to phototherapy. However, her psoriatic rashes worsened after phototherapy, thus, treatment was changed to subcutaneous injection of adalimumab. She then developed inflammatory arthritis, dry mouth and worsening dyspnoea and psoriasiform rashes. Repeat spirometry showed worsening of transfer factor (from 76% to 51%). In light of this peculiar development, her previous laboratory investigations performed in the other private hospitals were retrieved. They were remarkable for positive Anti-nuclear antibodies which were of homogenous pattern and high in titre with Anti-Ro/SS-A positivity. Skin biopsy of the lesion displayed typical histology of psoriasis. This clinical scenario describes a case of psoriasis coexisting with "hibernating" lupus which was "awakened" by use of anti-TNF. With an assemblage of cutaneous signs, interstitial lung disease, arthritis without severe systemic involvement together with strong association with anti-Ro/SS-A antibody, subacute cutaneous lupus erythematosus (SCLE) is suspected to be the most likely underlying lupus that remained dormant and smouldering until it was triggered and worsened by the use of adalimumab and phototherapy. These are the pitfalls associated with the diagnosis of connective tissue diseases which have protean manifestation. This is clinically significant as the diagnosis will affect the choice of immunosuppressants and biologics. The learning point is, in clinical practice, incongruity of enigmatic clinical and histo-pathological findings mandate critical scrutiny and second look as starting biologics without a clear clinical picture is potentially harmful.Keywords: Lupus; Anti-TNF; Psoriasis; Interstitial lung disease; Anti-nuclear antibodies Case ReportWe report a case of a 64-year-old Chinese lady, presenting with two weeks' history of cough and breathlessness. At presentation, she was febrile and tachypnoeic. On chest auscultation, there were bilateral lung crepitations. Chest radiograph revealed bilateral pulmonary infiltrates. Her co-morbidity included plaque psoriasis that was treated with topical steroids and oral methotrexate for 4 years by a few private physicians prior to the current admission. Methotrexate was withheld and broad spectrum antibiotics were given for community acquired pneumonia. Her symptoms improved and she was discharged.A few weeks later, upon clinic review, she complained of worsening psoriatic rashes, persistent breathlessness and intermittent dry cough. A high resolution computed tomogra...

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“…There is progressively more evidence that cytokines are important players in the pathogenesis of LE. [12][13][14] Previous studies evaluated cytokines only in skin lesions 10,11 ; mucosal lesions have not been evaluated so far. The importance of Th2 or Th1 responses in LE has been increasingly debated and there is still no consensus on their specific relevance to the disease process.…”

Section: Discussionmentioning

confidence: 99%

“…Apoptosis may be an important mechanism leading to autoantigen presentation in cutaneous LE. [12][13][14][34][35][36][37][38][39] . In addition to promoting cell death and neoantigen generation, UV lights also induces and modulates immune and inflammatory mediators by increasing levels of both 36 IL-10 induces systemic immunosupression and tolerance by promoting Th2 response.…”

Section: Discussionmentioning

confidence: 99%

Manifestações orais do lúpus eritematoso: padrão das citocinas do infiltrado inflamatório

Marques¹

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Dedicatória DedicatóriaAo meu marido, Telmo, pelo seu enorme amor e dedicação a mim, pelo incentivo e apoio incondicional a todos os meus sonhos e pela satisfação com conquistas minhas mais do que com as próprias.Aos meus filhos, Gustavo e Giulia, pelo carinho, incentivo e compreensão pelas frequêntes ausências.À minha mãe, Lourdes, por ter me ensinado a prezar a busca pelo conhecimento e por sua dedicação, estímulo e presença, com seu amor incondicional, em todos os momentos da minha vida.Ao meu pai, Jarbas, pelos bons momentos que convivemos.Ao meu irmão, Jarbas Eduardo, antes de tudo um amigo, grande incentivador do meu crescimento profissional.Aos meus cunhados, Thiers, Simone e Maria Alice, que tornam a minha família ainda melhor. Agradecimentos AgradecimentosAo meu orientador, Prof. Dr. Marcello Menta S. Nico, por sua condução firme, segura e participativa, com contribuições e ensinamentos valiosos em todos os momentos do desenvolvimento deste estudo, a quem aprendi a admirar e respeitar por sua sabedoria e dedicação. Agradeço pelo privilégio de ter trabalhado ao seu lado. À Profª. Dra. Sílvia Vanessa Lourenço, pela profissional dedicada, solícita, participativa, um exemplo a ser admirado e seguido. Devo, principalmente ao seu incentivo, apoio, ajuda e ensinamentos, a realização deste estudo. À Profª. Dra. Miriam Nacami Sotto, pela confiança, incentivo e ajuda para que este estudo pudesse ser realizado. À Dona Eli Maria, pela eficiência e competência na resolução de nossas dúvidas.

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Pathophysiology of Cutaneous Lupus Erythematosus

Cited by 102 publications

References 243 publications

Cancer risk in cutaneous lupus erythematosus: a population-based cohort study

Cancer risk in cutaneous lupus erythematosus: a population-based cohort study

Hibernating Lupus

Manifestações orais do lúpus eritematoso: padrão das citocinas do infiltrado inflamatório

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