Subacute Cutaneous Lupus Erythematosus: Clinical Characteristics, Disease Associations, Treatments, and Outcomes in a Series of 90 Patients at Mayo Clinic, 1996-2011

• Published in: Mayo Clinic proceedings Vol. 92; no. 3; pp. 406 - 414
• Main Authors: Alniemi, Dema T, Gutierrez, Jr, Albert, Drage, Lisa A, Wetter, David A
• Format: Journal Article
• Language: English
• Published: England Frontline Medical Communications Inc 01-03-2017; Elsevier Limited
• Subjects: Antirheumatic Agents - therapeutic use; Care and treatment; Dosage and administration; Drug Hypersensitivity - complications; Drug Hypersensitivity - drug therapy; Female; Humans; Hydroxychloroquine; Hydroxychloroquine - therapeutic use; Lupus erythematosus; Lupus Erythematosus, Cutaneous - diagnosis; Lupus Erythematosus, Cutaneous - drug therapy; Lupus Erythematosus, Cutaneous - etiology; Lupus Erythematosus, Cutaneous - physiopathology; Male; Middle Aged; Minnesota; Outcome Assessment (Health Care); Patient outcomes; Prednisone; Retrospective Studies
• ISSN: 0025-6196; 1942-5546
• DOI: 10.1016/j.mayocp.2016.10.030

To characterize the clinical presentation, laboratory studies, disease associations, and treatments of subacute cutaneous lupus erythematosus (SCLE).
A retrospective review of 90 patients with SCLE at Mayo Clinic from January 1, 1996, through October 28, 2011, was performed.
The mean patient age at diagnosis was 61 years; 64 patients (71%) were women, and 11 cases (12%) were drug induced (1996-2000, no drug-induced cases; 2001-2005, 2 cases; 2006-2011, 9 cases). Seventeen of 59 patients (29%) with available data were smokers at the time of diagnosis. The SCLE lesions were photodistributed in 75 patients (83%), and 52 (58%) had papulosquamous morphologic findings. Anti-Ro/SS-A positivity was present in 84 of 85 patients tested (99%), whereas 32 of the 85 patients (38%) tested positive for anti-La/SS-B. Associated autoimmune connective tissue diseases included Sjögren syndrome (n=13, 14%) and systemic lupus erythematosus (SLE) (n=8, 9%). Eighteen patients (20%) had at least 4 American College of Rheumatology criteria for SLE; 1 had lupus nephritis, and none had neurologic or notable hematologic sequelae. The most common therapy was hydroxychloroquine, with a complete response noted in 34 of 46 patients (74%) with available follow-up data.
Twenty-eight percent of patients with SCLE (n=25) had an associated autoimmune connective tissue disease, although the severe sequelae of SLE, such as nephritis, were rare. The frequency of drug-induced SCLE increased during the study. Most patients responded to treatment with hydroxychloroquine.