Lupus Patients with Skin Conditions May Indicate Serious Complications

To this day, certain cases of systemic lupus erythematosus are killing patients, and a previous study looked into what exactly was the primary cause of these deaths related to the disease. Following the study, it was concluded that certain traits on the patient’s skin can serve as an indicator of what is known as systemic thrombotic vasculopathy, which can cause serious complications for those with lupus.

If this is discovered in patients diagnosed with systemic lupus erythematosus, long-term antiplatelet therapy must be started in order to treat the affected patient.  Along these same lines, Dr. Lipsker, professor of dermatology at the University of Strasbourg in France stated, “Those patients are at very high risk. Those are the lupus patients with the poorest prognosis. Those are the lupus patients who still die today.”

The insight could prove to be a vital one for the lupus community, as the indicator can help patients receive the necessary treatment they need in a timely manner. The study that was ultimately responsible for this discovery was a team known as the European Working Party.  For the research effort, a total of 1000 systemic lupus erythematosus patients were observed for 10 years. 

The population being observed consisted of individuals from seven different European countries.  In the first five years, it was found that the most common cause of death amongst the patients diagnosed with systemic lupus erythematosus patients were infections, as well as active, incurable, and worsening systemic lupus erythematosus patients.  The important discovery, however, was found in the past five years of the research effort.  In this time period, the leading cause of death amongst the observed population was due to thrombotic occurrences, of which included stroke, acute myocardial infarction, and pulmonary embolism.

In the event that a patient does in fact have thrombosis alongside their diagnosis of systemic lupus erythematosus, a variety of traits or indicators become prevalent.  According to a Dermatology News piece, written by Bruce Jancin, these skin conditions include, “atrophie blanche, pseudo-Degos lesions, livedo racemosa, acral nonpalpable purpura or reticulate erythema, cutaneous necrosis, splinter hemorrhage, thrombophlebitis, and nailfold telangiectasias.”  These different types of skin conditions can become obvious at any point in a patient's lupus diagnosis, ultimately revealing whether or not the patient will need additional treatment options moving forward.

In terms of unraveling these important signs in a patient’s skin, much of the skill in doing so is held by a dermatologist.  Non-dermatologists however, will struggle in making these key findings that are responsible for discovering thrombosis.  In Jancins’s article, this point is made obvious when it is mentioned that, “their [the non-dermatologists] practice guidelines often fail to recognize the diagnostic, therapeutic, and prognostic value of searching for these skin findings.  For example, recent British Society for Rheumatology guidelines on the management of SLE go into extensive detail on the importance of regular laboratory monitoring of hematologic, renal, and biochemical parameters – every 3 months in patients who are clinically quiet but serologically active, and every 6 months in those with inactive disease and no previous organ damage – but the guidelines make no mention of the skin clues to thrombotic vasculopathy.”

Without these indicators seen on a patient’s skin, a variety of serious repercussions exist, such as death.  The aforementioned study suggests this, as the deaths seen in systemic lupus erythematosus patients were due to thrombotic occurrences.  Dr. Lipsker makes this association when he mentions, “We know today that, 5 years after the initial diagnosis of SLE, the chief causes of morbidity and mortality are thrombotic events… you will find direct evidence of thrombosis by carefully examining the skin.” 

It is important to note that some cases wherein a patient shows signs of thrombotic symptoms will differ from others, however, specific scenarios almost always lead doctors to the proper conclusion.  A specific example of this includes thrombosis in the form of what is known as pseudo-Degos lesions.  In this case, the patient will often have an ivory colored hue to their skin and according to the Dermatology News article, “white depressed atrophic papules with a raised border composed of telangiectasias.”

What is lupus?

Lupus, or systemic lupus erythematosus, is classified as a type of autoimmune disease.  The condition exists when the immune system essentially acts against itself, resulting in inflammation and subsequent damage to a variety of body tissue.  Some of the primary regions of the body that systemic lupus erythematosus impacts include that of the joints, heart, skin, kidneys, lungs, brain, and blood vessels.  The symptoms that are often associated with the disease include fatigue, swollen and pain-filled joints, skin irritation, fever, as well as kidney problems.

To this day, researchers and scientists are still unsure as to what exactly causes systemic lupus erythematosus.  This being said, it is believed that the patient’s respective environment can in fact play a role in their diagnosis.  These potential triggers include certain viruses, medications, ultraviolet rays, trauma, as well as physical or emotional stress. With systemic lupus erythematosus, it has yet to be linked to genetics (the disease running in the family), leading scientists to believe that the primary cause is in fact environmental triggers.

With more than 200,000 cases of lupus in the United States each year, the condition is said to affect more women than men.  Symptoms are even said to present itself during pregnancy as well as menstrual periods.  Some theories suggest that this was due to the estrogen levels prominent in women, however more research is required to confirm this theory.

The future for patients with lupus

As the study mentioned above suggests, hope is in fact prevalent for the lupus community because of this discovery of this serious indicator. If patients identify this early enough, they could, in turn, treat their condition early. Doing so can reduce the death rates common with thrombotic symptoms in systemic lupus erythematosus patients. 

As the subsequent treatment options arise, it is imperative for patients to continue to maintain their condition.  This can still enable patients to lead a healthy lifestyle free of reduced joint pain and other common symptoms.  This diligence, paired with the support from others around them, can ultimately lead to a better life for all patients diagnosed with some form of systemic lupus erythematosus.