A study of cutaneous manifestations in systemic lupus erythematosus

INTRODUCTION: Systemic lupus erythematosus (SLE) is an autoimmune disease with multiorgan involvement. The skin is the second most commonly affected organ. SLE with skin lesions can produce considerable morbidity resulting from painful skin lesions, alopecia, disfigurement, etc. Skin lesions in patients with lupus may be specific (LE specific) or may be non specific (LE non specific). Acute cutaneous LE (Lupus specific) has a strong association with systemic disease and non-specific skin lesions always indicate disease activity. Therefore, a thorough understanding of the cutaneous manifestations of SLE is essential for most efficient management. AIMS AND OBJECTIVES: To determine the following in the cases of SLE: 1. Age incidence, 2. Sex incidence, 3. Precipitating factors, 4. To assess the various types of cutaneous lesions in patients with SLE, 5. To evaluate the relation between skin lesions and other systemic involvement, MATERIALS AND METHODS: Study design: Cross sectional observational study. Study sample: 62 patients. METHODOLOGY: All patients with SLE attending Dermatology Outpatient Department and from Rheumatology Dept. Detailed case history of each patient with special attention to cutaneous lesions is taken. Gender, age, marital and family history, history of autoimmune diseases, sunlight exposure, smoking, drugs and relapses is asked for. Clinical features including LE specific and LE nonspecific lesions were noted. Detailed dermatological examination with inclusion of histopathological finding by skin biopsy as and when required. RESULTS: The commonest age group to be affected was observed to be second and third decade. Female preponderance was seen with a female to male ratio of 7:1. Multiple precipitating factors are involved in the clinical manifestation of disease. Photosensitivity was the commonest among the precipitating factors. Fever, easy fatigability, diffuse hair loss, and arthralgia were the common symptoms seen. Malar rash was the commonest disease specific lesion and diffuse hair loss was the commonest non specific but disease skin lesion. Generalized macular papular rash was associated with active disease. Musculoskeletal system was the commonest system involved and renal involvement was associated with the most morbidity. Antinuclear antibodies were positive in all patients in this study. CONCLUSION: Cutaneous manifestations in SLE can yield valuable diagnostic as well as prognostic information. As skin lesions are associated with increased morbidity, proper understanding of cutaneous manifestations is necessary for early diagnosis and effective intervention in patients with SLE