CHRONIC CUTANEOUS LUPUS-ERYTHEMATOSUS IN THE LUPUS-ERYTHEMATOSUS SPECTRUM - RETROSPECTIVE STUDY OF 136 PATIENTS

Objectives: The aim of this retrospective study of 136 patients was to specify the natural history and the systemic prognosis of chronic cut aneous lupus erythematosus, It has been stated that in most of the cas es, the disease only affects the skin. Methods: From 10 October 1980 t o 31 December 1990, 136 patients with the following criteria were incl uded in this retrospective study: clinical signs suggestive of chronic cutaneous lupus erythematosus, characteristic histology, insufficient evidence for the diagnosis of systemic lupus erythematosus. Results: The prevalence of systemic clinical involvement in the population unde r study was nearly the same as in the general population. The followin g biologic or immunologic abnormalities were quite common: leukopenia, lymphopenia, thrombopenia (significantly more frequent among patients having widespread chronic cutaneous lupus erythematosus), low titers of complement levels, positive antinuclear antibodies (usually at a lo w titer). Eleven out of the 136 patients developed systemic lupus eryt hematosus, most often over 5 years after the onset of the cutaneous le sions. Four cases out of these 11 had poor prognosis: renal and/or neu rologic involvement. Conclusion: This data suggests that patients with chronic cutaneous lupus erythematosus could benefit from long-term fo llow up, since the course to systemic disease occurs in only a few. Us ually, antimalarials used singly or in combination with topical steroi ds may lead to the clearing of the lesions. Thalidomide will occasiona lly be useful whenever the disease is unresponsive to the preceeding m easures.