Title: Clinical Patterns of Cutaneous and Mucosal Lesions in Patients with Systemic Lupus Erythematosus

Authors: Puspanjuli Sahu, Carounanidy Udayashankar, Prasenjeet Mohanty, Kavita Vasudevan

 DOI: https://dx.doi.org/10.18535/jmscr/v7i3.196

Abstract

Introduction: SLE is an auto-immune disease with diverse patterns of auto-antibody production with multi-organ involvement. Cutaneous illness often precedes the systemic involvement, giving the opportunity to recognize the disease process much before the systemic complaints are expressed.

Objective: To evaluate the clinical pattern of cutaneous and mucosal lesions in patients with SLE using the Gilliam’s system of classification and to look for the various immunological markers of SLE in them.

Methodology: A hospital-based cross-sectional descriptive study in which Forty five consecutive patients of SLE who fulfilled the revised American college of rheumatology (ACR) criteria for the classification of SLE were included.

Results: Among the LE-specific skin lesions, ACLE lesions were exclusively seen in 28 patients, SCLE lesions were seen exclusively in 3 patients, CCLE lesions were exclusively seen in 2 patients, whereas a combination of ACLE lesions along with CCLE lesions were seen in 12 patients. ACLE was found to be the most common LE-specific skin lesion (40/45, 88.89%), followed by CCLE (14/45, 31.11%). Among the LE-non-specific skin lesions, oral ulceration was the most common, seen in 84% of patients, followed by telogen effluvium (76%). Raynaud’s phenomenon was the most common (20%) LE- nonspecific vasculopathy.

Conclusions: Cutaneous manifestations are some of the commonest and earliest manifestations of SLE. Various LE-specific skin lesions and LE-non-specific skin lesions, as described by Gilliam, aid in the diagnosis and management of SLE. Immunological markers like Anti-ds DNA antibody might act as a predictive marker for renal involvement in SLE.

Keywords: SLE, Gilliam’s classification, Antinuclear antibodies, ACR criteria

References

  1. Cervera R, Jimenez S, Font J, Ingelmo M. The epidemiology of SLE: a review of the current data with special emphasis on the lessons from the ‘Euro-lupusCohort’. APLAR J Rheumatol 2003;6:150-7.
  2. Wong KL, Hawkins BR, Wong RW. Immunogenetics in Chinese patients with SLE. Scand J Rheumatol 1991;20:110-4
  3. Yell JA, Mbuagbaw J, Burge SM.Cutaneous manifestations of systemic lupus erythematosus. Cutaneous manifestations of SLE.British J Dermatol 1996;135:355-62
  4. Sontheimer RD. The lexicon of cutaneous lupuserythematosus-a review and personal perspective on the nomenclature and classification of the cutaneous manifestations of lupus erythematosus. Lupus 1997;6:84-95
  5. Gilliam JN, Sontheimer RD. Skin manifestations of SLE. Clin Rheum Dis 1982;8:207-18.
  6. Costner MI Sontheimer RD, Provost TT. Lupus Erythematosus. In:Sontheimer RD, Provost TT, editors .Cutaneous manifestations ofrheumatic diseases, 2nd ed, Lippincott Williams & Wilkins, 2004:15
  7. Masi AT, Kaslow RA. Sex effects in SLE: A clue to pathogenesis.Arthritis Rheum 1978;21:480
  8. Malaviya AN, Singh RR, Kumar De A, Kumar A, Aradhye S. SLE in Northern India 1988;36:476-80
  9. Ward MM. Prevalence of physician-diagnosed systemic lupus erythematosus in the United States: Results from the third National Health and Nutrition Examination Survey. J Womens Health (Larchmt) 2004;13:713-8.
  10. Fritzler MJ, Drugs recently associated with lupus syndrome. Lupus 1994;3:455-9.
  11. Wysenbeek AJ, Guedj D, Amit M, Weinberger A. Rash in SLE:Prevalence and cutaneous and non cutaneous manifestations. Ann Rheum Dis 1992;51:717-9.
  12. Kuhn A, Sontheimer RD, Ruzicka T. Clinical manifestations of cutaneous lupus erythematosus. In: Kuhn A, Lehmann P, Ruzicka T:Cutaneous Lupus Erythematosus. Heidelberg: Springer, 2004:59–92.
  13. Kuhn A, Ruzicka T. Classification of cutaneous lupus erythematosus. In: Kuhn A,Lehmann P, Ruzicka T: Cutaneous lupus erythematosus. Heidelberg: Springer, 2004:53–58.
  14. Hallegua DS, Wallace DJ. Gastrointestinal manifestations of systemic lupus erythematosus. Curr Opin Rheumatol. 2000;12:379-385.
  15. Zeevi R, Vojvodi D, Risti B, Pavloviæ MD, Stefanoviæ D, Karadagliæ D. Skin lesions: An indicator of disease activity in SLE? Lupus 2001;10:364-7.
  16. Sirka CS, Padhi T, Mohanty P, Patel DK, Parida PR, Kar CR: Bullous systemic lupus erythematosus: response to dapsone in two patients. Indian J Dermatol Venereol Leprol 2005;71:54-56.
  17. Akrekar SM, Bichile LS. cutaneous vasculitis in lupus: A turning point in the history of the disease? A case report and review of literature. J India Rheumatol Assoc 2005;13:29-31.
  18. Grigor R, Edmonds J, Lewconia R et al, Systemic lupus erythematosus.Ann Rhum Dis 1978;37: 121-8.
  19. Cervera R, Khamashta MA, Font J, 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 (Baltimore). 2003;82:299-308.
  20. Kole Ak, Ghosh A : Cutaneous manifestation of systemic lupus erythematosus in a tertiary referral center. Indian J Dermato.l 2009;54(2):132-136.
  21. Fries JW, Mendrick DL, Rennke HG. Determinants of immune complex–mediated glomerulonephritis. Kidney Int. 1988;34:333-45.
  22. Avina-Zubieta JA, Galindo-Rodriguez G, Kwan-Yeung L, et al: Clinical evaluation of various selected ELISA kits for the detection of anti-DNA antibodies. Lupus. 1995;4:370-4.
  23. Haugbro K, Nossent JC, Winkler T, Figenschau Y, Rekvig OP. AntidsDNA antibodies and diseases classification in antinuclear antibodies positive patients: the role of analytical diversity. Ann Rheum Dis. 2004;63(4):386-94
  24. Sherer Y, Gorstein A, Fritzler MJ, Shoenfeld Y. Autoantibody explosion in systemic lupus erythematosus: more than 100 different antibodies found in SLE patients. Semin Arthritis Rheum 2004;34:501-37.

Corresponding Author

Carounanidy Udayashankar

Department of Dermatology, Venereology & Leprology, Indira Gandhi Medical College & Research Institute, Kathirkamam, Pondicherry, 605009

Mobile: 09787731275, Email: This email address is being protected from spambots. You need JavaScript enabled to view it.