Background/Purpose: Epidemiological studies have shown that discoid lupus erythematosus (DLE) has a higher incidence and prevalence in minorities, particularly Black individuals. Racial differences in clinical features amongst DLE patients are not well understood. The objective of this retrospective cohort study was to examine the differences in DLE lesion distribution and characteristics of Black individuals compared to non-Black individuals.

Methods: Patients were recruited from the University of Texas Southwestern cutaneous lupus erythematosus (CLE) registry from January 2009 to June 2020. Adult DLE patients with a reported race/ethnicity and Cutaneous Lupus Erythematosus Disease Area and Severity Index (CLASI) scores were included in this study. Patients were excluded if they had an additional CLE subtype, or if they were < 18 years old. DLE lesion locations and characteristics based on CLASI scores were the primary outcome variables. The primary predictor variable was race, which was categorized into Blacks and non-Blacks. Additional predictor variables included age at initial visit, gender, disease duration at initial visit, follow up duration, smoking status and presence or absence of SLE. SKINDEX-29+3 qualify of life scores were secondary outcome measures. Univariate analyses were performed to determine demographic differences and to compare lesion location, lesion characteristics, and quality of life scores between Black and non-Black patients. Multivariable logistic regression was performed to determine significant predictors of DLE lesion location.

Results: 183 DLE patients (112 Black and 71 non-Black) were included in this study. Black DLE patients had worse baseline CLASI damage scores compared to non-Black DLE patients (median: 10.0 (IQR: 6.0-14.5) vs. 6.0 (3.0-10.0), p< 0.001) (Table 1) and were more likely to have. In univariate analysis, Black patients were more likely to have scalp involvement [OR (95% CI): 2.54 (1.12-5.79), p=0.013] (Table 2). In multivariable analysis, Black patients had 2.54 (1.20-5.37) greater odds of having scalp involvement (p=0.015) and 1.97 (1.06-3.68) greater odds of having ear involvement (p=0.032) compared to non-Blacks. Black patients were more likely to have dyspigmentation (99% vs. 79%, p< 0.001) in any anatomical location), scalp (82% vs. 48%, p< 0.001), and ear (56% vs. 35%, p=0.006). They were also more likely to have scarring alopecia (79% vs. 56%, p=0.001) than non-Blacks (Table 3). No significant differences in SKINDEX-29+3 scores were seen between Black and non-Black patients with DLE.

Conclusion: Black DLE patients have important lesion location and characteristic differences compared to non-Black DLE patients. Signs of disease damage, particularly ear dyspigmentation, scalp dyspigmentation and scarring alopecia, can more frequently affect Black DLE patients and can help assist diagnosis and treatment plans. Our findings will help clinicians better understand racial differences in DLE presentation, which may lead to proper diagnosis and treatment initiation.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/differences-in-discoid-lupus-erythematosus-skin-lesion-distribution-and-characteristics-in-black-and-non-black-patients-a-retrospective-cohort-study/