Study examines risk factors for systemic lupus erythematosus development

Among patients with lupus erythematosus panniculitis resulting from cutaneous lupus erythematosus, male sex and discoid lupus erythematosus were risk factors for systemic lupus erythematosus development, according to a study.

“Lupus erythematosus panniculitis (LEP) occurs in 1% to 3% of patients with cutaneous lupus erythematosus (CLE),” Juliette Lemasson, MD, of the dermatology service at Hôpital Saint-Louis in Paris, and colleagues wrote. “LEP is characterized by recurrent nodules or plaques that can evolve to lipoatrophy and impair quality of life.”

However, a knowledge gap exists in the differences between LEP in patients with or without systemic lupus erythematosus (SLE). In addition, there is uncertainty surrounding the baseline features that may lead to LEP sequelae.

In the multicenter case series, 74 patients with biopsy-proven LEP were enrolled from nine hospitals in France between 2004 and 2020. The cohort was 89% women with a median age at diagnosis of 35 years (range, 8 to 74 years), while 44% reported smoking. Patients were followed for a median duration of 5.6 years

LEP lesions presented as nodules in 71% of the cohort, while 58% were plaques and 29% were both. Nearly three-quarters of the cohort had LEP lesions in multiple sites, with upper limb lesions being most common.

The researchers observed sequelae in 74% of the cohort, with 69% presenting lipoatrophy and hypopigmentation in five patients, hyperpigmentation in 16 patients, persistent alopecia in two patients and erythema in three patients.

While just more than half of the group had isolated LEP, 39% had another CLE subtype, including 59% with discoid lupus erythematosus (DLE) and 32% with SLE.

Among patients who developed SLE, this occurred before or simultaneous to LEP diagnosis in 65% of patients and after LEP diagnosis in 35%. SLE developed a median of 126 months (range, 3 to 384 months) after LEP diagnosis.

Multivariate analysis results showed that SLE was significantly associated with male sex (OR = 8.29; 95% CI, 1.52-45.11; P = .01), DLE (OR = 4.61; 95% CI, 1.46-14.56; P = .003) and lower limb involvement (OR = 6.54; 95% CI, 2.08-20.56; P = .01).

Regarding sequelae, significant associations were observed for smoking (OR = 4.31; 95% CI, 1.23-15.13; P = .04), multiple site involvement (OR = 3.83; 95% CI, 1.12-13.05; P = .008) and longer follow-up duration (P = .03).

The researchers said that the study was limited by the sample size of patients who progressed to SLE.