Federica Guicciardi1, Laura Atzori2, Angelo Valerio Marzano3, Simona Tavecchio3, Giampiero Girolomoni4, Chiara Colato5, Axel Patrice Villani6, Jean Kanitakis7, Christina Mitteldorf8, Rosanna Satta9, Bernard Cribier10, Laurence Gusdorf11, Maria Teresa Rossi12, Piergiacomo Calzavara-Pinton12, Isabel Bielsa13, Maria Teresa Fernandez-Figueras14, Werner Kempf15, Giorgio Filosa16, Luca Pilloni17, Franco Rongioletti18. 1. Department of Dermatology, Medical Science and Public Health, University of Cagliari, Cagliari, Italy. 2. Department of Dermatology, Medical Science and Public Health, University of Cagliari, Cagliari, Italy; SIDEMAST Dermatopathology Study Group, Italian Society of Dermatology. Electronic address: atzoril@unica.it. 3. Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milano, Italy. 4. Department of Medicine, Section of Dermatology, University of Verona, Verona, Italy. 5. Department of Pathology, Section of Diagnostics and Public Health, University of Verona, Verona, Italy. 6. Department of Dermatology, Ed. Herriot Hospital Group (Pav. R), Lyon, France. 7. Department of Dermatology, Ed. Herriot Hospital Group (Pav. R), Lyon, France; Task Force of Dermatopathology, European Academy of Dermatology and Venereology (EADV). 8. HELIOS Klinikum Hildesheim, Hildesheim, Germany; Department of Dermatology, Venereology, and Allergology, University Medical Center Göttingen, Gottingen, Germany. 9. Department of Dermatology, Clinical and Sperimental Medicine, University of Sassari, Sassari, Italy; SIDEMAST Dermatopathology Study Group, Italian Society of Dermatology. 10. Service de Dermatologie, Hôpital Civil, Centre Hospitalier Universitaire de Strasbourg, Strasbourg, France; Task Force of Dermatopathology, European Academy of Dermatology and Venereology (EADV). 11. Service de Dermatologie, Hôpital Civil, Centre Hospitalier Universitaire de Strasbourg, Strasbourg, France. 12. Department of Dermatology, University of Brescia, Brescia, Italy. 13. Department of Dermatology, Hospital Universitari Germans Trias i Pujol, Badalona, Spain. 14. Patologia Quirúrgica, Anatomia Patològica, Hospital Universitari General de Catalunya-Grupo Quirón Salud, Universitat Autònoma de Barcelona, Barcelona, Spain; Task Force of Dermatopathology, European Academy of Dermatology and Venereology (EADV). 15. Kempf und Pfaltz, Histologische Diagnostik, Zürich, Switzerland; Task Force of Dermatopathology, European Academy of Dermatology and Venereology (EADV). 16. UOC Dermatology, Jesi, Italy; SIDEMAST Dermatopathology Study Group, Italian Society of Dermatology. 17. Department of Surgical Science, Pathology Service, University of Cagliari, Cagliari, Italy. 18. Department of Dermatology, Medical Science and Public Health, University of Cagliari, Cagliari, Italy; Task Force of Dermatopathology, European Academy of Dermatology and Venereology (EADV); SIDEMAST Dermatopathology Study Group, Italian Society of Dermatology.
Abstract
BACKGROUND: Clinical and pathologic criteria to distinguish drug-induced subacute lupus erythematosus (DI-SCLE) from idiopathic (I-SCLE) are controversial. OBJECTIVE: The aim of the survey was a retrospective analysis of a consistent number of iatrogenous and idiopathic SCLE cases, by means of clinical and histopathologic investigation. METHODS: Eleven European university dermatology units collected all diagnosed cases from January 2000 to December 2016. Board-certified dermatopathologists reviewed the histopathologic specimens. Statistical analysis included Student t test, exact test of goodness-of-fit, Fisher's exact test, and the Cochran-Mantel-Haenszel test for repeated measures. RESULTS: Out of 232 patients, 67 (29%) belonged to the DI-SCLE group. Patients with DI-SCLE were significantly older and reported more systemic symptoms than those with I-SCLE. No statistical differences were found for presentation pattern or serology, while histopathology showed a significant association of mucin deposition (P = .000083), direct immunofluorescence positivity for granular immunoglobulin M, and C3 deposits on the basement membrane zone (P = .0041) for I-SCLE and of leukocytoclastic vasculitis (P = .0018) for DI-SCLE. LIMITATIONS: This is a retrospective study. CONCLUSION: An integrated clinical and immunopathologic evaluation is useful to differentiate I-SCLE from DI-SCLE. Older age at onset and more frequent systemic symptoms characterize DI-SCLE. Mucin deposition and immunofluorescence findings are found in I-SCLE, and leukocytoclastic vasculitis is found in DI-SCLE.
BACKGROUND: Clinical and pathologic criteria to distinguish drug-induced subacute lupus erythematosus (DI-SCLE) from idiopathic (I-SCLE) are controversial. OBJECTIVE: The aim of the survey was a retrospective analysis of a consistent number of iatrogenous and idiopathic SCLE cases, by means of clinical and histopathologic investigation. METHODS: Eleven European university dermatology units collected all diagnosed cases from January 2000 to December 2016. Board-certified dermatopathologists reviewed the histopathologic specimens. Statistical analysis included Student t test, exact test of goodness-of-fit, Fisher's exact test, and the Cochran-Mantel-Haenszel test for repeated measures. RESULTS: Out of 232 patients, 67 (29%) belonged to the DI-SCLE group. Patients with DI-SCLE were significantly older and reported more systemic symptoms than those with I-SCLE. No statistical differences were found for presentation pattern or serology, while histopathology showed a significant association of mucin deposition (P = .000083), direct immunofluorescence positivity for granular immunoglobulin M, and C3 deposits on the basement membrane zone (P = .0041) for I-SCLE and of leukocytoclastic vasculitis (P = .0018) for DI-SCLE. LIMITATIONS: This is a retrospective study. CONCLUSION: An integrated clinical and immunopathologic evaluation is useful to differentiate I-SCLE from DI-SCLE. Older age at onset and more frequent systemic symptoms characterize DI-SCLE. Mucin deposition and immunofluorescence findings are found in I-SCLE, and leukocytoclastic vasculitis is found in DI-SCLE.