Abstract
Introduction: Lupus erythematosus is an immune-mediated, inflammatory, chronic, multi-
systemic disease, with cutaneous involvement in most cases. Cutaneous involvement may precede systemic involvement by decades, or be a marker of activity. Cutaneous involvement of lupus is divided into specific and nonspecific lesions, depending on whether or not they have interface dermatitis on histopathology.
Objectives: To describe the clinical, epidemiological and histopathological characteristics of patients with lupus erythematosus with cutaneous manifestations who attend the Department of Dermatology of FCM-UNA from January 2008 to December 2018. 2018, regardless of age, patients with SLE associated lesions confirmed by pathology.
Method: Design: Descriptive cross-sectional observational study. Sample: Non-probabilistic of consecutive cases. Inclusion criteria: patients with lupus erythematosus of both sexes and any age who attended the Outpatient Clinic of the Department of Dermatology of the Hospital de Clínicas-UNA from January 2008 to December 2018, with skin lesions associated with lupus erythematosus. to December 2018, carriers of skin lesions associated with Lupus Erythematosus with anatomopathological confirmation. Sources of information: patients who attended the Chair of Dermatology and clinical histories of patients diagnosed with lupus erythematosus.
Results: Patients were predominantly females (79%) of reproductive age (32.7%). Most patients were from urban areas (56%) and housewives (37.7%). Sixty two percent reported sun exposure. Most patients had multiple lesions (71%), and 28% had facial lesions. Lesions were mostly lupus specific (68%), and classified a chronic cutaneous lupus erythematosus (CCLE) ( 56%). Among the nonspecific lesions vasculitis was the most frequent (38%). All patients received antimalarials and sun protection recommendations. Multidisciplinary management with rheumatology and other departments according to the case was frequent.
Conclusion: Adequately identifying these lesions provides fundamental data for the diagnosis and management of lupus patients; on many occasions these cutaneous and/or mucosal manifestations may reveal systemic activity.
References
(1) Cervera R, Khamashta MA, Font J, Sebastiani GD, Gil A, Lavilla P, et al. Morbidity and mortality in systemic lupus erythematosus during a 10-year period: a comparison of early and late manifestations in a cohort of 1,000 patients. Medicine 2003; 82(5): 299-308.
(2) Petri M, Orbai A-M, Alarcón GS, Gordon C, Merrill JT, Fortin PR, et al. Derivation and validation of the Systemic Lupus International Colla- borating Clinics classification criteria for systemic lupus erythema- tosus. Arthritis Rheum 2012; 64(8): 2677-86.
(3) Edworthy SM, Zatarain E, McShane DJ, Bloch DA. Analysis of the 1982 ARA lupus criteria data set by recursive partitioning methodology: new insights into the relative merit of individual criteria. J Rheumatol 1988; 15(10):1493-8.
(4) Piette JC. Updating the American College of Rheumatology criteria for systemic lupus erythematosus: comment on the letter by Hochberg. Arth- ritis Rheum 1998;41(4):751.
(5) Sánchez-Schmidt JM, Pujol-Vallverdú RM. Diagnóstico diferencial de las lesiones cutáneas en el lupus eritematoso. Semin Fund Esp Reumatol 2006;7(1): 12-26.
(6) Kuhn A, Wenzel J, Weyd H. Photosensitivity, apoptosis, and cytokines in the pathogenesis of lupus erythematosus: a critical review. Clin Rev Allergy Immunol 2014; 47(2): 148-62.
(7) Tsokos GC, Gordon C, Smolen JS. Systemic Lupus Erythematosus: A Companion to Rheumatology. Elsevier Health Sciences 2007. 602 p.
(8) Costenbader KH, Karlson EW, Mandl LA. Defining lupus cases for clinical studies: the Boston weighted criteria for the classification of systemic lupus erythematosus. J Rheumatol 2002; 29(12): 2545-50.
(9) Petri M, Magder L. Classification criteria for systemic lupus erythematosus: a review. Lupus 2004;13(11): 829-37.
(10) Navarra SV, Guzmán RM, Gallacher AE, Hall S, Levy RA, Jimenez RE, et al. Efficacy and safety of belimumab in patients with active systemic lupus erythematosus: a randomised, placebo-controlled, phase 3 trial. Lancet Lond Engl 2011; 377(9767): 721-31.
(11) Zhang Q, Liang Y, Yuan H, Li S, Wang J-B, Li X-M, et al. Integrated analysis of lncRNA, miRNA and mRNA expression profiling in patients with systemic lupus erythematosus. Arch Med Sci AMS 2019; 15(4): 872-9.
(12) Shvedova A, Yanamala N, Kisin E, Khailullin T, Birch M, Fatkhutdinova L. Integrated Analysis of Dysregulated ncRNA and mRNA Expression Profi les in Humans Exposed to Carbon Nanotubes. PLoS ONE 2016;11(3): 1-32.
(13) Iwata S, Tanaka Y. B-cell subsets, signaling and their roles in secretion of autoantibodies. Lupus 2016; 25(8): 850-6.
(14) Vázquez MA, Rojas E, Losanto J, Bauman K, Acosta ME, Avila G, et al. Características clínico-epidemiológicas de los pacientes de la cohorte Lupus Paraguay (2013-2014). Mem Inst Investig En Cienc Salud 2019; 17(1):69-74.
(15) Stojan G, Petri M. Epidemiology of Systemic Lupus Erythematosus: an update. Curr Opin Rheumatol 2018; 30(2):144-50.
(16) Furst DE, Clarke AE, Fernandes AW, Bancroft T, Greth W, Iorga SR. Incidence and prevalence of adult systemic lupus erythematosus in a large US managed-care population. Lupus 2013; 22(1): 99-105.
(17) Housey M, DeGuire P, Lyon-Callo S, Wang L, Marder W, McCune WJ, et al. Incidence and prevalence of systemic lupus erythematosus among Arab and Chaldean Americans in southeastern Michigan: the Michigan Lupus Epidemiology and Surveillance Program. Am J Public Health 2015;105(5):74-79.
(18) Hermansen M-LF, Lindhardsen J, Torp-Pedersen C, Faurschou M, Jacobsen S. Incidence of Systemic Lupus Erythematosus and Lupus Nephritis in Denmark: A Nationwide Cohort Study. J Rheumatol. 2016; 43(7):1335-9.
(19) Hiraki LT, Feldman CH, Liu J, Alarcón GS, Fischer MA, Winkelmayer WC, et al. Prevalence, incidence, and demographics of systemic lupus erythematosus and lupus nephritis from 2000 to 2004 among children in the US Medicaid beneficiary population. Arthritis Rheum 2012; 64(8): 2669-76.
(20) Adinolfi A, Valentini E, Calabresi E, Tesei G, Signorini V, Barsotti S, et al. One year in review 2016: systemic lupus erythematosus. Clin Exp Rheu- matol 2016; 34(4): 569-74.
(21) Moroni G, Quaglini S, Radice A, Trezzi B, Raffiotta F, Messa P, et al. The Value of a Panel of Autoantibodies for Predicting the Activity of Lupus Nephritis at Time of Renal Biopsy. J Immunol Res 2015; 2015: 1-9.
(22) Rivas-Larrauri F, Yamazaki-Nakashimada MA. Systemic lupus erythema- tosus: Is it one disease? Reumatol Clin 2016; 12(5): 274-81.
(23) Hersh AO, Arkin LM, Prahalad S. Immunogenetics of cutaneous lupus erythematosus. Curr Opin Pediatr 2016; 28(4): 470-5.
(24) Durosaro O, Davis MDP, Reed KB, Rohlinger AL. Incidence of cutaneous lupus erythematosus, 1965-2005: a population-based study. Arch Dermatol 2009; 145(3): 249-53.
(25) Sontheimer RD. The lexicon of cutaneous lupus erythematosus--a review and personal perspective on the nomenclature and classification of the cutaneous manifestations of lupus erythematosus. Lupus 1997; 6(2): 84-95.
(26) Bielsa Marsol I, Rodríguez Caruncho C. Manifestaciones cutáneas del lupus eritematoso. Inmunología 2010; 29(3): 100-10.
(27) Bijl M, Reefman E, Limburg PC, Kallenberg CGM. Inflammatory clearance of apoptotic cells after UVB challenge. Autoimmunity 2007; 40(4): 244-8.
(28) Meller S, Winterberg F, Gilliet M, Müller A, Lauceviciute I, Rieker J, et al. Ultraviolet radiation-induced injury, chemokines, and leukocyte recruit- ment: An amplification cycle triggering cutaneous lupus erythematosus. Arthritis Rheum 2005; 52(5): 1504-16.
(29) Kuo C-F, Grainge MJ, Valdes AM, See L-C, Luo S-F, Yu K-H, et al. Familial Aggregation of Systemic Lupus Erythematosus and Coaggrega- tion of Autoimmune Diseases in Affected Families. JAMA Intern Med 2015; 175(9): 1518-26.
(30) Sanchez E, Nadig A, Richardson BC, Freedman BI, Kaufman KM, Kelly JA, et al. Phenotypic associations of genetic susceptibility loci in syste- mic lupus erythematosus. Ann Rheum Dis 2011; 70(10): 1752-7.
(31) Cui YX, Fu CW, Jiang F, Ye LX, Meng W. Association of the interleukin-6 polymorphisms with systemic lupus erythematosus: a meta-analysis. Lupus 2015; 24(12): 1308-17.
(32) Di Martino B. Dermatitis de interfase por drogas de las formas leves a las severas. Una visión dermatopatológica. Our Dermatol Online 2012; 3(1): 10-16.
(33) Dickey BZ, Holland KE, Drolet BA, Galbraith SS, Lyon VB, Siegel DH, et al. Demographic and clinical characteristics of cutaneous lupus erythematosus at a paediatric dermatology referral centre. Br J Dermatol 2013; 169(2): 428-33.
(34) Callen JP. Drug-induced cutaneous lupus erythematosus, a distinct syndrome that is frequently unrecognized. J Am Acad Dermatol 2001; 45(2): 315-6.
(35) Bielsa I, Herrero C, Font J, Mascaró JM. Lupus erythematosus and toxic epidermal necrolysis. J Am Acad Dermatol 1987; 16(6): 1265-7.
(36) Reich A, Marcinow K, Bialynicki-Birula R. The lupus band test in systemic lupus erythematosus patients. Ther Clin Risk Manag 2011; 7: 27-32.
(37) Redissi A, Litaiem N. Lupus Pernio. En: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing 2019. Disponible en: http://www.ncbi. nlm.nih.gov/books/NBK536968/
(38) Proaño López NE, Arévalo Ordóñez IM. Elementos que reumatólogos y dermatólogos deberían conocer sobre el lupus eritematoso sistémico. Rev Cuba Reumatol 2016; 18(2): 150-4.
(39) Reyes MV, Vanaclocha Sebastián F. Tratamiento del lupus eritematoso cutáneo resistente. Semin Fund Esp Reumatol 2012;13(3):77-84.
(40) Tan TC, Fang H, Magder LS, Petri MA. Differences between male and female systemic lupus erythematosus in a multiethnic population. J Rheuma-tol 2012; 39(4): 759-69.
(41) Puig, Ruíz de Morales J, Dauden E, Andreu J, Cervera R, Adán A, etal. La prevalencia de diez enfermedades inflamatorias inmunomediadas (IMID) en España. Rev Esp Salud Pública 2019; 93(1): 1-19.