Systemic Lupus Erythematosus in Patients with Darker Skin

00:01 Welcome to our lecture on systemic lupus erythematosus (SLE).

00:07 This is a chronic autoimmune inflammatory disease of unknown cause that can affect virtually any organ of the body.

00:17 It's more than 90% of cases occur in women with a female-to-male ratio of 11 to 1.

00:26 Frequently starts at the childbearing age.

00:31 There's higher prevalence in individuals with darker skin tones.

00:35 The specific cause of SLE is unknown, however, factors leading to SLE include the genetic predisposition, exposure to sunlight, viral infection like EBV, hormones, toxins that are found in cigarette smoke, as well as medication, as listed.

01:03 Let's quickly look at the pathophysiology of SLE.

01:07 The manifestations of SLE are due to loss of regulation of the patient's immune system.

01:13 This leads to the creation of immune complexes.

01:17 Immune complexes deposit throughout the body, leading to different clinical manifestations.

01:26 So in 80% of patients, skin manifestations are the first sign of SLE. There are LE or lupus-specific manifestations which are localized in sun-exposed areas. So these include the face, the V-shaped lesions on the neck, the back, as well as lesions induced or aggravated by exposure to UV radiation.

01:54 Now let's take a look at LE nonspecific manifestations.

01:59 One is this nail fold capillary telangiectasia, Raynaud's phenomenon, diffuse hair thinning called lupus hair, urticaria, we spoke about this earlier and cutaneous vasculitis.

02:20 Systemic features include general weakness, chronic pain, fever, which sometimes flares.

02:29 The joints may also be involved, and one can get arthritis or synovitis.

02:37 Cardiovascularly one m ay find pericarditis or pericardial effusion.

02:43 In the lungs, there may be evidence of pleuritis or pleural effusion, so lupus may also involve the kidneys, and this may present with costs in the urine as well as glomerulonephritis, the so-called lupus nephritis.

03:00 Central nervous system may also involved.

03:03 The patient may present with seizures, psychosis, and confusion. The diagnosis of SLE.

03:12 So what do we need for diagnosis? The following is a diagnosis criteria for SLE.

03:20 This includes clinical criteria and immunological criteria as listed on the slide. In order to diagnose SLE, you need at least two clinical and two immunological criteria or a biopsy proven lupus nephritis.

03:42 Differential diagnosis includes systemic sclerosis.

03:48 Stroke and syndrome, which can present with dry eyes and mouth ulcers due to lymphocytic infiltration of exocrine glands.

03:57 It may co-exist with SLE, giving you the overlap syndrome.

04:03 Rheumatoid arthritis is also a differential for SLE.

04:10 The management of SLE includes general measures.

04:13 Sun protection. As we mentioned that sun exposure is one of the triggers of lupus.

04:20 Broad spectrum sunscreen and good protective clothing and avoidance of the sun, particularly between 11 and 4 p.m., depending on your geographical location.

04:32 Smoking cessation. Diet and nutrition and having a balanced diet is a recommendation.

04:41 Topical therapy includes topical corticosteroids and calcineurin inhibitors.

04:49 Systemic therapy includes the following.

04:53 It is important when using chloroquine to monitor for retinopathy, particularly in patients who are high risk.

05:01 So if one looks at skin of color patients and patients with lighter skin, the patients with lighter skin tend to have florid erythema.

05:15 Patients with dark skin, as I mentioned, the erythema is not obvious in the so-called butterfly rash may not be that conspicuous because the redness is masked by melanin, and therefore you tend to get plum colored or dusky lichenoid patches, which could be signifying erythema in dark skin.