Skin and beyond: Demographics,clinical features and systemic involvement of cutaneous lupus erythematosus in Pakistani population

Abstract

Background

Lupus erythematosus (LE) is an autoimmune disease with skin being the most important organ involved and presents as LE specific and LE nonspecific lesions.

Objective

To determine the clinical demographics, systemic involvement and disease impact on daily lives of patients of cutaneous lupus erythematosus (CLE).

Methodology

A cross sectional study of a total of 135 patients who presented with cutaneous symptoms were enrolled. Informed consent was taken. Detailed History, examination, clinical features, laboratory and radiograph investigations were conducted to assess the systemic involvement of internal organs.

Results

Of the 135 patients, 73.3% patients were female and 26.7% were male. Mean age was 28.1 years and duration of CLE was 8.4 months. 56.3% of patients belonged to the rural area. Isolated Chronic CLE (CCLE) was observed in 35.5%, CCLE with overlap Acute CLE (ACLE) in 30.3% and Isolated ACLE in 33.3%. Only two patients had Sub acute CLE (SCLE). In LE specific lesions, limited and generalized discoid rash was noted in 33.3% and 17.7% respectively. 46.6% patients had Malar rash. Oral and nasal ulcers were observed in 51.1 %. Non scarring alopecia was seen in 53.3% of patients. Scarring alopecia was observed in 35.5%. 34% patients had Raynaud’s phenomenon, 23.7% had Periungual telangiectasia, and 14.8% had Vasculitis. In systemic involvement, joint involvement was observed in 49 patients (36.3%), renal in 48 patients (35.6%), haematological in 42 patients (31.1%), serositis, 23 patients (17%) and neurological in 14 patients (10.4%). No difference in sexes was observed. ANA positivity was seen in 61 patients, (45.1%), most of whom were females. (56.5%) Anti DSDNA was positive in 42 patients (31.1%) of which 40 were women. Mean DLQI was 11.01 ± 8.2. 45 patients had no or slight effect on their lives. 22.9%, 27.4% and 16.3% had moderate, large and very large effects of CLE on their lifestyle.

Conclusion

The clinical characteristics of cutaneous lupus is similar to other studies, but the renal involvement is higher with cutaneous involvement in this study, while Serositis is less prevalent. Localized discoid lupus did not show extra cutaneous involvement, but showed significant impact on daily life.