Karolinska Institutet, Department of Clinical Sciences, Danderyd Hospital, Division of Dermatology, Danderyd, Sweden.
Lupus. 2010 Sep;19(10):1187-94. doi: 10.1177/0961203310367656. Epub 2010 May 25.
The prevalence and prognostic value of cutaneous manifestations in patients with systemic lupus erythematosus (SLE) is not clear due to a lack of distinct criteria. Our aim was to investigate the prevalence of cutaneous manifestations in SLE patients according to strict dermatological classification, compare the results with other studies and to assess differences in serological markers between patients with and without cutaneous lupus erythematosus (CLE). Secondary aims were to investigate the validity of the criteria 'malar rash' and 'photosensitivity' for SLE diagnosis. We included 260 consecutive SLE patients, and 164 with skin complaints were examined by a dermatologist. CLE was found in 23% of the 260 SLE patients. There was agreement on the presence of malar rash in only 60% of patients seen by both rheumatologists and dermatologists. A history of polymorphous light eruption (PLE) was found in 42% of patients. Raynaud's phenomenon was significantly more common in patients with CLE. In addition, four malignant melanomas were found. Based on our findings, we suggest that the American College of Rheumatology (ACR) criteria for SLE diagnosis include histopathologically confirmed CLE as one criterion, and that the criteria photosensitivity and malar rash should be re-defined. Regular examination by a dermatologist is called for in SLE patients.
由于缺乏明确的标准，系统性红斑狼疮（SLE）患者皮肤表现的患病率及其预后价值尚不清楚。我们旨在根据严格的皮肤科分类调查 SLE 患者皮肤表现的患病率，将结果与其他研究进行比较，并评估有和无皮肤红斑狼疮（CLE）患者的血清学标志物差异。次要目的是调查“蝶形红斑”和“光过敏”标准对 SLE 诊断的有效性。我们纳入了 260 例连续的 SLE 患者，164 例有皮肤症状的患者由皮肤科医生进行检查。260 例 SLE 患者中有 23%存在 CLE。只有 60%的患者同时被风湿病医生和皮肤科医生诊断为蝶形红斑。42%的患者有光化性类网织细胞增生症病史。雷诺现象在 CLE 患者中更为常见。此外，还发现了 4 例恶性黑色素瘤。基于我们的发现，我们建议美国风湿病学会（ACR）SLE 诊断标准将组织病理学证实的 CLE 作为一个标准包含在内，并且应重新定义光过敏和蝶形红斑的标准。建议 SLE 患者定期由皮肤科医生进行检查。
