Dermoscopic Markers of Activity in Subtypes of Cutaneous Lupus Erythematosus in Skin of Color: An Observational Study

Abstract Background: Dermoscopy may detect the activity of cutaneous lupus erythematosus (CLE), which can aid physicians in intervening at the earliest to halt systemic progression and irreversible scarring. Aim and Objectives: The objective was to record different and specific dermoscopic activity features of CLE in skin of color (Fitzpatrick Skin Type IV–VI). Patients and Methods: Dermoscopy was done and recorded, and revised- cutaneous lupus erythematosus disease area and severity index (R-CLASI) activity score (R-CLASI-A) was calculated in de novo cases of CLE/cases not taken treatment for at least 1 month (n = 53).The correlation between the R-CLASI-A score and dermoscopy was analyzed using a point – biserial correlation. Results: The average R-CLASI-A ofdiscoid lupus erythematosus (DLE) (n = 35, 66%), subacute cutaneous lupus erythematosus (SCLE) (n = 8, 15.1%), and acute cutaneous lupus erythematosus (ACLE) (n = 10, 18.8%) were 21.83 ± 19.36, 31.75 ± 17.58, and 32.6 ± 21.69, respectively. In DLE, linear-non-branched, non-curved (r = 0.21, P = 0.216), linear-branched (r = 0.16, P = 0.372), linear-curved vessels (r = 0.26, P = 0.127), erythema (r = 0.16, P = 0.16), white scales (r = 0.22, P = 0.821), diffuse scales (r = 0.12, P = 0.312), and perifollicular white color (r = 0.25, P = 0.657) had low positive correlation with R-CLASI-A, whereas yellow/brown scales (r = -0.18, P = 0.208), brown (r = -0.21, P = 0.225) and white structureless areas (r = - 0.14, P = 0.746), and erosions (r = -0.12, P = 0.509) showed low negative correlation. In SCLE, linear-non-branched, non-curved (r = 0.55, P = 0.162), linear-curved (r = 0.4, P = 0.321), dotted vessels (r = 0.35, P = 0.396), dense scales (r = 0.17, P = 0.693), follicular plugs (r = 0.17, P = 0.693), perifollicular white halo (r = 0.17, P = 0.693), and brown structureless areas (r = 0.11, P = 0.802) showed moderate to low positive correlation. Presence of scales (r = -0.58, P = 0.131), patchy distribution (r = -0.58, P = 0.131), and fine, scarce scales (r = -0.55, P = 0.123) had moderate negative correlation. Presence of dottedvessels (r = -0.45, P = 0.192), fine, scarce scales (r = -0.35, P = 0.317), patchy scales (r = -0.5, P = 0.145), and follicular plugging (r = -0.57, P = 0.085) showed high negative correlation in ACLE. Although none of the features showed statistically significant strong positive or negative correlations in DLE, linear non-branched, non-curved vessels and the presence of scales showed the highest positive and negative correlations with the R-CLASI-A score in SCLE. Gray and brown dots and follicular plugs showed maximum positive and negative correlations in ACLE without statistical significance. Limitation: Small sample size in each subgroup, specially in SCLE and ACLE, is the limitation of the study. Conclusion: Dermoscopy is useful to diagnose CLE, and the present study demonstrates the preliminary potential of dermoscopy to pick up the signs of activity, which can be validated by further larger studies.