Karasińska Aneta, Dańczak-Pazdrowska Aleksandra, Polańska Adriana
Department of Dermatology, Poznan University of Medical Sciences, Poznan, Poland.
Skin Res Technol. 2025 Aug;31(8):e70208. doi: 10.1111/srt.70208.
Cutaneous lupus erythematosus (CLE) is a chronic inflammatory autoimmune disease with not fully understood pathogenic mechanisms. The lesions in CLE are mainly located on the facial skin, that is why searching for noninvasive methods to facilitate differential diagnosis is justified. High-frequency ultrasonography (HFUS) is a noninvasive diagnostic tool, enabling the assessment of all skin layers without leaving a scar, in contrast to skin biopsy, which is the gold diagnostic standard in this disease. The aim of this study was to assess the usefulness of HFUS in the diagnostic process of patients with CLE, taking into account individual types of the disease, its severity and activity.
For the purpose of analyzing the HFUS results, the studied lupus erythematosus (LE) group was divided into three subgroups: acute cutaneous lupus erythematosus (ACLE), subcutaneous lupus erythematosus (SCLE), and chronic cutaneous lupus erythematosus (CCLE). Fifty-seven active lesions and nine inactive lesions were examined. The analysis was performed using a 20 MHz Dermascan C linear head (version 3) (Cortex Technology; Hadsund, Denmark). In the analysis of the HFUS image, skin thickness, echogenicity of the skin, and the presence and thickness of subepidermal low echogenic band (SLEB) were taken into consideration. The image was compared with the healthy skin of the contralateral area and, if this was not possible, with the skin in the area of the lesion.
HFUS images of 17 patients with active CLE (29.8%) showed the presence of SLEB and a statistically significant relationship between SLEB thickness and disease activity expressed by Cutaneous Lupus Erythematosus Disease Area and Severity Index (CLASI-A) (p = 0.022). The average skin thickness of active foci was significantly greater than the average thickness of healthy skin (p = 0.001). Additionally, in the group of patients with CCLE, 55.6% showed increased skin echogenicity, showing its statistically significant inverse correlation with CLASI-A (p = 0.004).
SLEB can be treated as an indicator of the activity of the disease process. HFUS allows the assessment of certain features of healthy and diseased skin without performing a biopsy, but it cannot replace histological examination in the case of CLE diagnosis.
皮肤红斑狼疮（CLE）是一种慢性炎症性自身免疫性疾病，其致病机制尚未完全明确。CLE的皮损主要位于面部皮肤，因此寻找非侵入性方法以辅助鉴别诊断是合理的。高频超声检查（HFUS）是一种非侵入性诊断工具，与皮肤活检（本病的金标准诊断方法）不同，它能够在不留下疤痕的情况下评估所有皮肤层。本研究的目的是评估HFUS在CLE患者诊断过程中的实用性，同时考虑疾病的个体类型、严重程度和活动度。
为分析HFUS结果，将研究的红斑狼疮（LE）组分为三个亚组：急性皮肤红斑狼疮（ACLE）、亚急性皮肤红斑狼疮（SCLE）和慢性皮肤红斑狼疮（CCLE）。共检查了57个活动性皮损和9个非活动性皮损。使用20MHz Dermascan C线性探头（版本3）（Cortex Technology；丹麦哈松）进行分析。在HFUS图像分析中，考虑了皮肤厚度、皮肤回声以及表皮下低回声带（SLEB）的存在和厚度。将图像与对侧区域的健康皮肤进行比较，如果无法进行比较，则与皮损区域的皮肤进行比较。
17例活动性CLE患者（29.8%）的HFUS图像显示存在SLEB，且SLEB厚度与皮肤红斑狼疮疾病面积和严重程度指数（CLASI-A）所表示的疾病活动度之间存在统计学显著相关性（p = 0.022）。活动性病灶的平均皮肤厚度显著大于健康皮肤的平均厚度（p = 0.001）。此外，在CCLE患者组中，55.6%显示皮肤回声增强，显示其与CLASI-A呈统计学显著负相关（p = 0.004）。
SLEB可被视为疾病进程活动度的指标。HFUS无需进行活检即可评估健康和患病皮肤的某些特征，但在CLE诊断中不能替代组织学检查。
