Clinicoepidemiologic profile of Discoid Lupus Erythematosus and Its Relationship with Systemic Diseases

Öz

Aim: Lupus erythematosus (LE) is an autoimmune disease with cutaneous and systemic forms. Discoid lupus erythematosus
(DLE) is the most common type of cutaneous LE. The majority of DLE lesions are localized in the sun-exposed areas.
DLE patients may progress to systemic LE (SLE) with a range of 5-30%. Therefore, patients with DLE should be monitored
carefully in terms of SLE findings.
Materials and Methods: Sixty-seven patients with DLE aged above 18 years were included in the study, between the
years of 2004 and 2020. Demographic data, accompanying diseases, and blood values were recorded. Pregnant women
were not included in the study.
Data were analyzed with SPSS 25.0 program. Pearson's chi-square test (and Fischer's exact test when relevant) was used
for the analysis of categorical variables, and independent sample T-test for quantitative variables.
Results: The study included 23 women (34.3%) and 44 men (65.7%) with a mean age of 41.94±13.85 years. We found that
antinuclear antibody (ANA) positivity, speckled patern ANA, SS-A positivity, and a history of autoimmune disease were
significantly related to SLE progression (p:0,024; 0,007; 0,000; 0,021, respectively).
Conclusion: Generalized lesions, ANA positivity, joint pain, anemia, leukopenia, thrombocytopenia, and increased
sedimentation rates are considered to be indicative of SLE progression. We found that a history of autoimmune disease, ANA
(especially speckled pattern) positivity, and SS-A positivity may be related to SLE progression. We think that being aware of
the predictive features for the SLE progression will enable determining risky patients and monitoring them closely.

Anahtar Kelimeler

• discoid lupus erythematosus
• systemic lupus erythematosus
• DLE
• SLE
• sytstemic disease

Diskoid Lupus Eritematozus Hastalarının Klinikoepidemiyolojik Profili ve Sistemik Hastalıklarla İlişkisi

Öz

Amaç: Lupus eritematozus (LE), kütanöz ve sistemik tipleri olan otoimmun bir hastalıktır. Diskoid LE (DLE), en sık görülen
kutanöz formudur. DLE lezyonlarının çoğu güneş gören yerlerde lokalizedir.
DLE hastalarının %5-30’u sistemik LE (SLE)’ye ilerleyebilmektedir. Bu nedenle, DLE hastaları SLE bulguları açısından
dikkatlice değerlendirilmelidir.
Gereç ve Yöntemler: Çalışmaya 2004-2020 yılları arasında, 18 yaş üzeri 67 DLE hastası dahil edildi. Hastaların demografik
bilgileri, eşlik eden hastalıkları ve kan değerleri kaydedildi. Hamileler çalışma dışında bırakıldı.
Veriler SPSS 25.0 programıyla analiz edildi. Kategorik veriler, Pearson ki-kare testi (gerektiğinde Fischer’ın kesin testi),
kantitatif veriler bağımsız T-testi ile değerlendirildi.
Bulgular: Çalışmada, yaş ortalamaları 41.94±13.85 olan 23 kadın (34.3%), 44 erkek (65.7%) hasta bulunmaktaydı. ANA
pozitifliği, benekli tarzda ANA pozitifliği, SS-A pozitifliği ve otoimmun hastalık öyküsünün anlamlı bir şekilde SLE’ye
ilerleme ile ilişkili olduğu görüldü (sırasıyla p:0,024; 0,007; 0,000; 0,021).
Sonuç: Generalize lezyonlar, ANA pozitifliği, eklem ağrısı, anemi, lökopeni, trombositopeni ve artmış sedimentasyon hızı
gibi bulguların SLE’ye ilerleyen hastaların tespitinde yardımcı rol oynadığı düşünülmektedir. Çalışmamızda otoimmun
hastalık öyküsü, ANA (özellikle benekli tipte) ve SS-A pozitifliğinin SLE’ye ilerleme ile ilişkili olduğu gösterilmiştir.
SLE’ye ilerleme konusunda dikkat edilmesi gereken özelliklerin bilinmesiyle, riskli hastaların tespiti ve yakın takibinin
sağlanabileceğini düşünmekteyiz.

Anahtar Kelimeler

• diskoid lupus eritematozus
• sistemik lupus eritematozus
• DLE
• SLE
• SLE’ye ilerleme
• sistemik hastalık

Kaynakça

1. 1. Ji YZ, Mei XL, Wei FL, Liu SR, Ji YB. A secondary discoid lupus erythematosus induced by scald of edible oil: An illustration of Koebner phenomenon. J Cosmet Dermatol. 2020; 19 :1699-701.
2. 2. Zhou W, Wu H, Zhao M, Lu Q. New insights into the progression from cutaneous lupus to systemic lupus erythematosus. Expert Rev Clin Immunol. 2020; 16: 829-37.
3. 3. Grönhagen CM, Nyberg F. Cutaneous lupus erythematosus: An update. Indian Dermatol Online J. 2014; 5: 7-13.
4. 4. Uva L, Miguel D, Pinheiro C, Freitas JP, Marques Gomes M, Filipe P. Cutaneous manifestations of systemic lupus erythematosus. Autoimmune Dis. 2012; 2012: 834291.
5. 5. Yavuz GO, Yavuz IH, Bayram I, Aktar R, Bilgili SG. Clinic experience in discoid lupus erythematosus: a retrospective study of 132 cases. Postepy Dermatol Alergol. 2019; 36: 739-43.
6. 6. Lenormand C, Lipsker D. Lupus erythematosus: Significance of dermatologic findings. Ann Dermatol Venereol. 2021; 148: 6-15.
7. 7. Little AJ, Vesely MD. Cutaneous Lupus Erythematosus: Current and Future Pathogenesis-Directed Therapies. Yale J Biol Med. 2020; 93:81-95.
8. 8. Chanprapaph K, Tankunakorn J, Suchonwanit P, Rutnin S. Dermatologic Manifestations, Histologic Features and Disease Progression among Cutaneous Lupus Erythematosus Subtypes: A Prospective Observational Study in Asians. Dermatol Ther (Heidelb). 2021; 11: 131-47.

9. 9. Cooper EE, Pisano CE, Shapiro SC. Cutaneous Manifestations of "Lupus": Systemic Lupus Erythematosus and Beyond. Int J Rheumatol. 2021; 2021: 6610509.
10. 10. Wieczorek IT, Propert KJ, Okawa J, Werth VP. Systemic Symptoms in the Progression of Cutaneous to Systemic Lupus Erythematosus. JAMA Dermatol. 2014; 150: 291–6.
11. 11. McDaniel B, Sukumaran S, Koritala T, Tanner LS. Discoid Lupus Erythematosus. [Updated 2021 Dec 6]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK493145/. (28.01.2022’de alınmıştır)
12. 12. Insawang M, Kulthanan K, Chularojanamontri L, Tuchinda Papapit, Pinkaew S. Discoid lupus erythematosus: description of 130 cases and review of their natural history and clinical course. J Clin Immunol Immunopathol Res. 2010; 2: 1-8.
13. 13. Callen JP. Cutaneous lupus erythematosus: a personal approach to management. Australas J Dermatol. 2006; 47: 13-27.
14. 14. Kim A, Chong BF. Photosensitivity in cutaneous lupus erythematosus. Photodermatol Photoimmunol Photomed. 2013; 29: 4-11.
15. 15. Sanders CJ, Van Weelden H, Kazzaz GA, et al. Photosensitivity in patients with lupus erythematosus: a clinical and photobiological study of 100 patients using a prolonged phototest protocol. Br J Dermatol. 2003; 149: 131-7.
16. 16. Kuhn A, Aberer E, Bata-Csörgő Z, et al. S2k guideline for treatment of cutaneous lupus erythematosus - guided by the European Dermatology Forum (EDF) in cooperation with the European Academy of Dermatology and Venereology (EADV). J Eur Acad Dermatol Venereol. 2017; 31: 389-404.
17. 17. Lin TL, Wu CY, Juan CK, et al. Long-Term Risk of Autoimmune Diseases other than Systemic Lupus Erythematosus in Cutaneous Lupus Erythematosus-Alone Patients: A 10-Year Nationwide Cohort Study. Dermatology. 2022; 238: 92-100.
18. 18. Kunzler E, Hynan LS, Chong BF. Autoimmune Diseases in Patients With Cutaneous Lupus Erythematosus. JAMA Dermatol. 2018; 154: 712-6.
19. 19. Shi KY, Kunzler E, Hynan LS, Chong BF. Autoimmune disease development before and after cutaneous lupus erythematosus diagnosis. Br J Dermatol. 2020; 182: 1309-10.
20. 20. Bencze G, Lakatos L. Relationship of systemic lupus erythematosus to rheumatoid arthritis, discoid lupus erythematosus, and sjogren's syndrome a clinical study Ann Rheum Dis. 1963; 22: 273-5.
21. 21. Bencze G. Relationship of Systemic Lupus Erythematosus (SLE) to Rheumatoid Arthritis (RA), Discoid Lupus Erythematosus (DLE) and Sjögren's Syndrome: A Clinical Study. Scand J Rheumatol. 1987; 16: 191-6.
22. 22. Enginar AU, Nur H, Kacar C. Coexistence of ankylosing spondylitis and discoid lupus: A case report. North Clin Istanb. 2019; 6: 412-4.
23. 23. Azarisman SM, Heselynn H. Systemic lupus erythematosus presenting as parotitis and secondary Sjogren's syndrome. Singapore Med J. 2007; 48: 60-1.
24. 24. Singh AG, Crowson CS, Singh S, et al. Cancer risk in cutaneous lupus erythematosus: a population-based cohort study. Rheumatology (Oxford). 2016; 55: 2009-13.
25. 25. Westermann R, Zobbe K, Cordtz R, Haugaard JH, Dreyer L. Increased cancer risk in patients with cutaneous lupus erythematosus and systemic lupus erythematosus compared with the general population: A Danish nationwide cohort study. Lupus. 2021; 30: 752-61.
26. 26. Song L, Wang Y, Zhang J, et al. The risks of cancer development in systemic lupus erythematosus (SLE) patients: a systematic review and meta-analysis. Arthritis Res Ther. 2018; 20: 270.
27. 27. Blake SC, Daniel BS. Cutaneous lupus erythematosus: A review of the literature. Int J Womens Dermatol. 2019; 5: 320-9.
28. 28. Grönhagen C, Fored C, Granath F, Nyberg F. Cutaneous lupus erythematosus and the association with systemic lupus erythematosus: A population-based cohort of 1088 patients in Sweden. Br. J. Dermatol. 2011; 164: 1335–41.
29. 29. Chong BF, Song J, Olsen NJ. Determining risk factors for developing systemic lupus erythematosus in patients with discoid lupus erythematosus. Br J Dermatol. 2012; 166: 29-35.
30. 30. Bitar C, Menge TD, Chan MP. Cutaneous manifestations of lupus erythematosus: a practical clinicopathological review for pathologists. Histopathology. 2022; 80: 233-50.
31. 31. Al-Saif FM, Al-Balbeesi AO, Al-Samary AI, et al. Discoid lupus erythematosus in a Saudi population: Clinical and histopathological study. JSSDDS. 2012; 16: 9-12.
32. 32. Tang WYM, Chan LY, Lo KK. Discoid lupus erythematosus in Hongkong Chinese: a review of 12 cases. HKMJ. 1996; 2: 239-45.
33. 33. Prystowsky SD, Gilliam JN. Antinuclear antibody studies in chronic cutaneous discoid lupus erythematosus. Arch Dermatol. 1977; 113: 183-6.
34. 34. Böckle BC, Stanarevic G, Sepp NT. Detection of Ro/SS-A antibodies in lupus erythematosus: what does it mean for the dermatologist? J Am Acad Dermatol. 2013; 68: 385-94.
35. 35. Oh EH, Kim EJ, Ro YS, Ko JY. Ten-year retrospective clinicohistological study of cutaneous lupus erythematosus in Korea. J Dermatol. 2018; 45: 436-43.