Clinical features of the skin lesions of patients with chronic cutaneous lupus erythematosus and examination of the factors that are relevant to its transformation to systemic lupus erythematosus

Background: Chronic cutaneous lupus erythematosus (CCLE) is a well-known autoimmune cutaneous disease that is part of the lupus erythematosus (LE) spectrum. Objective: The aim of this study is to elucidate the clinical and laboratory features and the possible factors that are relevant to the aggravation of CCLE, as well as the possible precipitating factors for the transformation of cutaneous LE into multi-organ systemic disease. Methods: A total of forty Korean patients with CCLE were selected for the study. We performed clinical examinations for the lesion-morphology and topographic distribution, as well as tests for the LE-related laboratory abnormalities, the precipitating factors for aggravation and the factors relevant to systemic lupus erythematosus (SLE). Results: Among these forty CCLE patients, thirty-two patients (80.0%) had discoid erythema (DLE) lesions and 39 patients (97.5%) had cutaneous CCLE lesions that appeared on the head and neck areas. Twenty-nine patients (72.5%) had more than 3 CCLE lesions. All of the laboratory and clinical features of SLE were observed more frequently in the patients with widespread DLE with multiple lesions than in those patients with localized DLE. The most frequent aggravating factors that were recognized among these forty patients with CCLE were UV light, cold-exposure, physical trauma, pregnancy and smoking. Transformation into SLE developed in three patients (7.5%) during a 4-year period, and the most relevant findings related to the transformation into SLE were positive findings for leukopenia, antinuclear antibodies, anti-DNA antibodies and an increase of the erythrocyte sedimentation rate. Conclusion: Among these forty Korean cases of CCLE, multiple lesions of DLE on the head and neck areas were the most frequent clinical form, and this pattern is similar to the pattern seen in Caucasian people. The most frequent aggravating factor observed in individual patients was UV light. Patients with a widespread form of CCLE may have some laboratory findings of SLE such as leukopenia, antinuclear antibodies, anti-DNA antibodies or an elevated erythrocyte sedimentation rate. These patients should be observed closely because their disease might be transformed to SLE