Comparative Analysis of Acute Cutaneous Lupus Erythematosus with Subacute and Chronic Cutaneous Lupus Erythematosus: Clinical and Immunological Study of 308 Patients

Background: Patients with acute cutaneous lupus erythematosus (ACLE) usually have systemic manifestations and there is a strong association between ACLE and systemic lupus erythematosus (SLE) involvement. However, there is scarce information on the differences in the systemic manifestations when compared with subacute cutaneous lupus erythematosus (SCLE) and chronic cutaneous lupus erythematosus (CCLE). Objective: To analyse and compare the prevalence and characteristics of the main clinical and immunological manifestations of patients with ACLE, who were initially attending a Department of Dermatology, with respect to those with SCLE and CCLE. Methods: A total of 38 patients with ACLE were studied. The clinical and serological characteristics of all the patients were collected in a chart review. These patients were compared to 112 patients with SCLE and 158 with CCLE that were previously reported. Results: Patients with ACLE had a higher prevalence of mucous membrane ulcers (p=0.012), livedo reticularis (p=0.036), vasculitis (p=0.030), nephropathy (p=0.025) and serositis (p=0.036) compared with patients with SCLE. Patients with ACLE also had a higher frequency of livedo reticularis (P=0.001), mucous membrane ulcers (P<0.001), vasculitis (P<0.001), arthralgias (P<0.001), arthritis (P<0.001), nephropathy (P<0.001) and serositis (P=0.005) compared with patients with CCLE. Furthermore, we detected that patients with ACLE had a higher prevalence of decreased C4 and CH50 levels than SCLE, and a higher frequency of decreased C3, C4 and CH50 levels than CCLE. Conclusions: In our series, differences in the expression of ACLE, CCLE and SCLE were found with respect to the distribution and type of lesions, the systemic features and the immunological findings.