Background/Purpose: Cutaneous lupus erythematosus (CLE) is a chronic autoimmune disease marked by skin lesions that can vary in appearance and severity. Subacute cutaneous erythematosus (SCLE), acute cutaneous erythematosus (ACLE), and chronic cutaneous erythematosus (CCLE) make up the CLE categories and CCLE may be further subtyped. While dyspigmentation and scarring are recognized as complications of discoid lupus erythematosus (DLE), no studies have investigated scarring and dyspigmentation across all the CLE categories and subtypes.

Methods: To better characterize dyspigmentation and scarring in CLE, we conducted a cross-sectional review of our IRB-approved CLE database at the University of Pennsylvania. Patients were divided by category and CCLE subtype. Dyspigmentation and scarring were quantified using components of the CLE Disease Area and Severity Index damage (CLASI-D) score. Data on dyspigmentation and scarring were captured from the patient visit where dyspigmentation was highest. The Kruskal-Wallis test was used to compare dyspigmentation and scarring scores across CLE categories and CCLE subtypes. A Post-hoc Dunn analysis was used to check for pairwise comparisons between groups. The Spearman’s rank-order correlation test was used to assess the correlations between dyspigmentation and scarring.

Results: A total of 500 patients were included in the study. Dyspigmentation and scarring significantly differed between CLE categories and CCLE subtypes (p< .01). Across categories, CCLE had the highest medians for dyspigmentation and scarring. Across CCLE subtypes, DLE had the highest medians for dyspigmentation and scarring. Dyspigmentation and scarring were significantly positively correlated in CCLE, DLE, and LE Panniculitis (p< .01).

Conclusion: Our findings show that scarring and dyspigmentation do not necessarily correlate in CLE except for CCLE as a whole and the CCLE subtypes of DLE and LE panniculitis. These CLE categories and CCLE subtypes are known to have higher rates of long-lasting disease damage. Dyspigmentation and scarring correlation differences highlight the importance of accurate assessment and documentation of both elements of damage. Our results reflect important differences in the CLE categories and CCLE subtypes which may be helpful for clinicians and patients as they navigate the course of the disease.

Key: CLE = cutaneous lupus erythematous, ACLE = acute cutaneous lupus erythematous, SCLE = subacute cutaneous lupus erythematous, CCLE = chronic cutaneous lupus erythematous, DLE = discoid lupus erythematous, LET = tumid lupus erythematous, Q1 = first quartile, Q3 = third quartile. Values for median dyspigmentation and median scarring correlate to Cutaneous Lupus Erythematous Disease Area and Severity Index damage score dyspigmentation and scarring aspects respectively. P-values in columns in columns three and five represent differences in dyspigmentation and scarring across CLE categories and CCLE subtypes using the Kruskal-Wallis test. R-values represent correlations between dyspigmentation and scarring across CLE categories and CCLE subtypes using the Spearman’s rank-order correlation test.

Figure 1. Comparison of median dyspigmentation and scarring scores across Cutaneous Lupus Erythematosus Categories. Dunn-Bonferroni post-hoc test run to analyze pairwise comparisons following Kruskal-Wallis test. CLE = cutaneous lupus erythematosus, ACLE = acute cutaneous lupus erythematous, SCLE = subacute cutaneous lupus erythematous, CCLE = chronic cutaneous lupus erythematous.

Figure 2. Correlation of scarring and dyspigmentation in Cutaneous Lupus Erythematosus Categories & Subtypes. Spearman’s rank-order correlation between scarring and dyspigmentation scores for each patient visit where dyspigmentation was highest. (A) CCLE (B) DLE (C) Panniculitis. r = Spearman’s rank correlation coefficient, CCLE = chronic cutaneous lupus erythematous, DLE = discoid lupus erythematous.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/differences-in-dyspigmentation-and-scarring-across-cutaneous-lupus-erythematosus-categories-and-subtypes/