Clinicopathological characteristics of cutaneous lupus erythematosus patients in Bangladesh

Introduction
Nearly all epidemiologic studies have involved patients with systemic lupus erythematosus (SLE). Few authors have investigated the characteristics of patients with cutaneous lupus erythematosus (CLE).

Aim: To describe the clinical and pathologic characteristics of a series of patients diagnosed with CLE.

Material and methods
This is a descriptive retrospective cross-sectional study carried out using the consecutive registered records of 218 patients attending the ‘Lupus Clinic’ in Chittagong Medical College Hospital during the period between 2010 and 2020. The activity and damage of CLE were assessed according to the Cutaneous Lupus Erythematosus Disease Area and Severity Index (CLASI).

Results
There were 187 (85.8%) females and 31 (14.2%) males, with the female:male ratio being 6 : 1. The mean age was 30.0 ±11.7 years. The chronic cutaneous lupus erythematosus (CCLE) patients numbered 154 (70.6%), followed by acute cutaneous lupus erythematosus (ACLE) n = 46 (21.1%), and subacute cutaneous lupus erythematosus (SCLE) n = 18 (8.3%). In LE-specific skin lesions, the most common manifestation was photosensitivity, 198 (90.8%), followed by discoid rash, 155 (71.1%) and maculo-papular lupus rash, 55 (25.2%). Among LE-nonspecific skin lesions, the most common manifestation was non-scarring alopecia, 123 (56.4%), followed by livedo reticularis, 18 (8.3%), Raynaud’s phenomenon, 17 (7.8%), vasculitis, 15 (6.9%), periungual telangiectasia, 7 (3.2%), erythema multiforme, 6 (2.7%) and leg ulcers, 5 (2.3%). Antinuclear antibodies (ANA) were the most common type of autoantibody (n = 132, 60.5%) followed by anti-ds DNA (n = 91, 41.7%) and anti-phospholipid antibodies (n = 9, 4.1%).

Conclusions
CCLE was the most common subtypes of CLE. Photosensitivity was the most common clinical manifestation, whereas ANA were the most frequent autoantibodies of the LE patients of this region. Patients with different subtypes of CLE have distinct clinical and pathological characteristics.