피부홍반루푸스 환자들의 인구학적, 임상적 및 실험적 특징: 한국인 환자들을 대상으로 한 단일기관 후향적 연구

Abstract

Demographic and Clinicolaboratory Features of Cutaneous Lupus Erythematosus: A Retrospective Single Center Study in Korea

Oh, Eui Hyun Dept. of Medical Science The Graduate School Hanyang University

Background: An understanding of the differences in clinical manifestations and laboratory abnormalities between subtypes of cutaneous lupus erythematosus (CLE) is still lacking. Objective: The purpose of this study was to analyze demographic, clinical, and laboratory features of CLE according to three main presentation subsets: acute (ACLE), subacute (SCLE), and chronic (CCLE). Methods: A retrospective analysis was performed on data from patients who were diagnosed with CLE and were seen between March 2005 and September 2015 in a tertiary referral dermatology clinic. We compared demographic data and clinical and laboratory findings between three different CLE groups—ACLE, SCLE, and CCLE. Results: An overall sample of 220 patients with CLE consisted of 67 patients with ACLE, 25 patients with SCLE, and 135 patients with CCLE. Seven patients were diagnosed with two CLE subtypes concurrently; two patients had CCLE combined with ACLE and five patients had CCLE combined with SCLE. The ACLE group was younger at age of onset and had a lower average damage score according to the Revised Cutaneous Lupus Erythematosus Disease Area and Severity Index (RCLASI); however, joint complaints were most commonly observed in all three groups. Mean RCLASI activity score was highest in SCLE patients. Patients with CCLE had an older onset age, lower prevalence of anemia and elevated erythrocyte sedimentation rate, and showed the lowest positivity for anti-dsDNA and anti-Sm antibodies, which were frequently found in the ACLE group. When each group was subsequently subdivided according to existence of systemic lupus erythematosus (SLE), CCLE patients who only had skin lesions showed lower female predominance, lower extracutaneous manifestation, and fewer laboratory abnormalities. Conclusions: Patients with different CLE subtypes present with diverse clinical and hematological/immunological characteristics. ACLE and SCLE were almost always associated with development or existence of SLE, whereas CCLE did not predict presence of systemic LE. However, in terms of cutaneous complications, CCLE tended to cause more scarring than ACLE which might lead to permanent disfiguring, which can impair patients’ quality of life. Considering their distinct manifestations, a comprehensive awareness of each CLE subtype is important for achieving a favorable prognosis through appropriate diagnosis and management.

Key words: Activity, cutaneous lupus erythematosus, damage, immunology, hematologic abnormality, systemic lupus erythematosus