Funding sources This material is based upon work supported by the Department of Veterans Affairs (Veterans Health Administration, Office of Research and Development, Biomedical Laboratory Research and Development) and by the National Institutes of Health (NIH K24-AR 02207) to V.P.W.
Clinical and Laboratory Investigations
The impact of skin damage due to cutaneous lupus on quality of life†
Article first published online: 18 FEB 2014
Published 2013. This article is a U.S. Government work and is in the public domain in the USA.
British Journal of Dermatology
Volume 170, Issue 2, pages 315–321, February 2014
How to Cite
Verma, S.M., Okawa, J., Propert, K.J. and Werth, V.P. (2014), The impact of skin damage due to cutaneous lupus on quality of life. British Journal of Dermatology, 170: 315–321. doi: 10.1111/bjd.12653
Conflicts of interest V.P.W. serves as a consultant for the Lupus Foundation of America, Pfizer, Medimmune, Genentech, Novartis, Celgene, Stiefel, Rigel, Astion, Amgen, Infinity Pharmaceuticals, Sanofi-Aventis and UBC; has received research grants from Amgen, Celgene and Rigel; and has partial stock ownership of UV Therapeutics. The University of Pennsylvania holds the copyright for the Cutaneous Lupus Erythematosus Disease Area and Severity Index and the Cutaneous Disease and Activity Severity Index.
Plain language summary available online
- Issue published online: 18 FEB 2014
- Article first published online: 18 FEB 2014
- Accepted manuscript online: 1 OCT 2013 12:29AM EST
- Manuscript Accepted: 23 SEP 2013
- Department of Veterans Affairs
- Veterans Health Administration
- Office of Research and Development
- Biomedical Laboratory Research and Development
- National Institutes of Health. Grant Number: NIH K24-AR 02207
Patients with more severe cutaneous lupus erythematosus (CLE) have a poorer quality of life (QoL). Racial and ethnic disparities have been reported in disease activity and outcomes in systemic lupus erythematosus, but similar information is not available for CLE.
To evaluate the impact of lupus-related skin damage on skin-specific QoL, and to analyse differences stratified by ethnic background.
Data collected included sex, race, diagnosis and Cutaneous Lupus Erythematosus Disease Area and Severity Index (CLASI) and Skindex-29 scores. These parameters were analysed at the initial and last visits. CLASI damage scores (dyspigmentation and scarring) and activity scores were collected, grouped by ethnicity, and correlated with Skindex-29. Overall, 223 patients were analysed at baseline, with 141 completing more than one study visit.
The majority of patients were white (63·7%), followed by African American (29·1%) and Asian American (4·0%). African American patients accounted for a disproportionate percentage of both localized (50%) and generalized discoid lupus erythematosus (DLE) (49%). Median CLASI damage scores differed significantly between the African American, white and Asian American patients, at both the first (8·5, 4·0, 7·0, respectively; P < 0·0001) and last visit (10·0, 6·0, 8·5, respectively; P < 0·01). CLASI damage scores in African Americans correlated with CLASI activity scores (Spearman r = 0·45, P = 0·0003).
There was no significant correlation between CLASI damage scores and Skindex domains overall. Individually, dyspigmentation and scarring also did not have a significant effect on QoL. Ethnic differences in patients with CLE were found: African American patients exhibited a high rate of DLE and experienced damage early in their disease course, frequently in conjunction with disease activity.