DOI: http://dx.doi.org/10.18203/issn.2455-4529.IntJResDermatol20183165

A clinical and epidemiological study on discoid lupus erythematosus

Geetharani Gopalan, Sudha R. Gopinath, Kothandaramasamy R., Sathesh Pandian

Abstract


Background: Discoid lupus erythematosus (DLE) is the commonest form of cutaneous lupus erythematosus.The objective of our study is to analyze the clinical and epidemiological aspects of DLE.

Methods: All clinically diagnosed cases of DLE attending the dermatology OPD from October 2010 to September 2012were included in the study. A detailed history, complete physical examination, biopsy for confirmation and other relevant investigations were done in all cases.

Results: The incidence was 4.79 per 10000 cases (51 of 106368 dermatology patients) showing female to male ratio of 4.1:1. Localized type was more common than the disseminated type. Few lesions (less than five) in a localized area without head and neck involvement were also classified as localized type in this study. Mucosal, verrucous, tumid and lupus panniculitis were the variants of DLE encountered. The sites involved were face, scalp, trunk, upper and lower limb in descending order of frequency. Antinuclear antibody (ANA) was positive in 22 of 30 cases done (73%). The systemic involvement was seen in 15 patients all of whom were diagnosed as systemic lupus erythematosus (SLE). Squamous cell carcinoma was seen in 2 cases of disseminated DLE.

Conclusions: Majority of patients had disease onset at 3rd to 5th decade showing female predominance. When compared to localized type, disseminated type was found more frequently in males. Early onset and severe disease was noted among offspring born to a patient suffering from disseminated DLE. Serious morbidity like lupus nephritis was observed only in 1 case. The occurrence of DLE over the herpes zoster scar was an interesting observation.


Keywords


DLE, Lupus nephritis, SLE, Squamous cell carcinoma

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References


Goodfield M, Dutz J, McCourt C. Lupus Erythematosus. In: Griffiths C, Barker J, Bleiker T, Chalmers R, Creamer D, eds. Rook's Textbook of Dermatology.9th ed. West Sussex: Wiley Blackwell; 2016: 51.2

Durosaro BS, Davis MD, Reed KB, Rohlinger AL. Incidence of Cutaneous Lupus Erythematosus, 1965-2005: A Population-Based Study. Arch dermatol. 2009;145(3):249-53.

Insawang M, Kulthanan K, Chularojanamontri L, Tuchinda P, Pinkaew S. Discoid lupus erythematosus: Description of 130 cases and review of their natural history and clinical course. J Clin Immunol Immunopathol. 2010;2(1):1-8.

Bajaj DR, Devrajani BR, Matlani BL. Discoid Lupus Erythematosus: A Profile. J Coll Physicians Surg Pak. 2010;20(6):361-4.

Jacyk WK, Damisah M. Discoid lupus erythematosus in the Nigerians. Br J Dermatol. 1979;100:131-5.

Callen JP. Chronic cutaneous lupus erythematosus. Clinical, laboratory, therapeutic, and prognostic examination of 62 patients. Arch Dermatol. 1982;118:412-6.

Tang WYM, Chan LY, Lo KK. Discoid lupus erythematosus in Hongkong Chinese: A review of 12 cases. HKMJ. 1996;2:239-45.

Handa F, Rani R, Garg R. Familial Discoid Lupus Erythematosus. IJDVL. 1973;39(5):213-5.

Belin DC, Bordwell BJ, Einarson ME, Rothfield NF. Familial discoid lupus erythematosus associated with heterozygote C2 deficiency. Arthritis Rheum. 1980;23(8):898-903.

Grundwald M, David M, Feuerman EJ. Appearance of lupus erythematosus in a patient with lichen planus treated by isoniazid. Dermatologica 1982; 162:172–7.

Hardy C, Palmer B, Muir K, Sutton A, Powell R. Smoking history, alcohol consumption, and systemic lupus erythematosus: A case-control study. Ann Rheum Dis. 1998;57(8):451-5.

Dhar S, Kanwar AJ. Discoid lupus Erythematosus in northern India: A study of 102 patients. Ind J Dermatol. 1996:41(4):118-21.

Arrico L, Abbouda A, Abicca I, Malagola R. Ocular complications in cutaneous lupus erythematosus: A systematic review with a Meta-Analysis of reported cases. J Ophthalmolo. 2015:254260:8.

Kuhn A, Richter-Hintz D, Oslislo C. Lupus erythematosus tumidus-a neglected subset of cutaneous Lupus erythematosus: Report of 40 cases. Arch Dermatol. 2000;136(8):1033-41.

Parish LC, Kennedy RJ, Hurley HJ. Palmar lesions in lupus erythematosus. Arch Dermatol. 1967;96(3):273–6.

Wilson CL, Burge SM, Dean D, Dawber RP. Scarring alopecia in discoid lupus erythematosus. Br J Dermatol. 1992;126(4):307–14.

Petri M, Orbai AM, Alarcón GS, Gordon C, Merrill JT, Fortin PR, et al. Derivation and Validation of the Systemic Lupus International Collaborating Clinics Classification Criteria for Systemic Lupus Erythematosus. Arthritis Rheum. 2012;64(8):2677-86.

David-Bajar KM, Bennion SD, DeSpain JD, Golitz LE, Lee LA. Clinical, Histologic, and Immunofluorescent Distinctions Between Subacute Cutaneous Lupus Erythematosus and Discoid Lupus Erythematosus. J Invest Dermatol. 1992;99(3):251-7.

Elenitsas R, Nousari CH, Seykora JT. Laboratory Methods. Lever's Histopathology of the Skin. 9th ed. Philadelphia: Lippincott Williams & Wilkins; 2005: 64.

Van der Meer-Roosen CH, Maes EPJ, Faber WR. Cutaneous lupus Erythematosus and autoimmune thyroiditis. Br J Dermatol. 1979;101:91–2.

Wojnarowska F. Simultaneous occurrence in identical twins of discoid lupus erythematosus and polymorphic light eruption. J R Soc Med. 1983;76(9):791–2.

Nyberg F, Hasan T, Puska P, Stephansson E, Häkkinen M, Ranki A, et al. Occurrence of polymorphous light eruption in lupus Erythematosus. Br J Dermatol. 1997;136(2):217-21.

Looi LM. Primary localised cutaneous amyloidosis in Malaysians. Australas J Dermatol. 1991;32(1):39–44.

Millard LG, Barker DJ. Development of squamous cell carcinoma in chronic DLE. Clin Exp Dermatol. 1978;3:161.

Lee NY, Daniel AS, Dasher DA, Morrell DS. Cutaneous Lupus After Herpes Zoster: Isomorphic, Isotopic, or Both? Pediatr Dermatol. 2013;30(6):110-3.

Kern AB, Schiff BL. Discoid Lupus Erythematosus Following Trauma Report of Cases and Analysis of a Questionnaire. Arch Dermatol. 1957;75(5):685-8.