DISCOID LUPUS ERYTHEMATOSUS: AN ANALYSIS OF ITS SYSTEMIC MANIFESTATIONS

Abstract

Chronic discoid lupus erythematosus has been regarded as primarily a skin disease with rare systemic manifestations. In order to determine the truth of this statement a complete history, physical examination and routine laboratory work was performed on a series of 41 patients with chronic discoid lupus erythematosus. Patients were divided into 2 groups: the localized discoid form with skin lesions above the chin, and the generalized discoid form with cutaneous involvement on the face and elsewhere. Sixteen of the 26 patients of the localized discoid group had evidence at some time in the course of their illness of arthritis, fever, Raynaud''s phenomenon, pleurisy, or other systemic changes by history and physical examination alone. Fourteen of the 15 cases of generalized discoid disease had such changes. If laboratory abnormalities such as leukopenia, elevated sedimentation rate, hyperglobulinemia or abnormal flocculation tests were considered, then 24 of the 26 with localized discoid disease and all 15 of the generalized discoid group showed such changes. Therefore, there was evidence of systemic involvement in 96% of this group of patients with chronic discoid lupus. Three different modes of onset of discoid lupus were found. Thirty-three patients had cutaneous changes initially, followed, in 45% of this group, by rheumatoid-like arthritis. Seven patients had rheumatoid arthritis prior to the appearance of discoid lesions. One patient had a biologic false-positive serologic test prior to her skin lesions. Classification of lupus erythematosus is an arbitrary one. There are many transitions between the types. Discoid lupus, from its inception, is a systemic disorder which is a variant of the more malignant acute disseminated form. The "benign" -appearing cutaneous lesion may be a herald of advanced systemic manifestations which may be present at the same time or at a later date, when the skin changes have healed. Therefore all these patients should have a thorough general medical survey.