Lupus is the condition that most frequently requires attention to skin problems, but it's far from the only reason for a rheumatologist's patient to see a dermatologist. In the case of lupus, however, the lesion may be a clue to prognosis.
Two presentations at the recent annual meeting of the American Academy of Dermatology compiled data about visits of rheumatology patients seeking help for skin problems.Although lupus was the most frequently represented condition, other rheumatologic disorders were also represented. What's more, what might have looked like an autoimmune or inflammatory problem was often something else entirely.Another report at the conference revealed outcomes for lupus patients who present with skin problems. The prospects for disease severity are different, depending on the type of lesion.The results are summarized in these slides, with hyperlinks to the reports in the captions.Â
Rheumatology and Rashes: Insights from the American Academy of Dermatology annual meeting.
There's considerable overlap between rheumatologic and dermatologic conditions, including systemic lupus erythematosus (SLE), psoriasis, scleroderma and dermatomyositis. Skin problems in these patients may not be related to the underlying condition.
In a 2-year retrospective review, dermatologists and rheumatologists at a multidisciplinary clinic found that lupus was the most common condition to present dermatologic problems, followed by rheumatoid arthritis and psoriatic arthritis. However dermatitis -- not a more specific diagnosis -- was the most common skin disorder among these patients. Samycia M et. al.Review and assessment of a combined dermatology and rheumatology clinic: Experiences from the DART Clinic, Abstract 513, American Academy of Dermatology Annual Meeting, March 20-24, 2015, San Francisco.
Lupus patients often present with rashes. Taken together, acne and dermatitis outrank cutaneous lupus as the cause.
Researchers at a Toronto Lupus Clinic have assessed the onset patterns and prognostic implications of cutaneous lupus. Their results reveal the likelihood that a lupus patient who presents initially without skin problems can expect them to develop in the future. Drucker AM et.al. Cutaneous disease is associated with higher early systemic lupus disease activity, Abstract 510, American Academy of Dermatology Annual Meeting, March 20-24, 2015, San Francisco.
In lupus, disease severity correlates with skin manifestations. Patients who have cutaneous lupus can expect worse outcomes than those who are unaffected. But discoid lupus is a different story entirely.
The take-home lessons: Not all "rashes" in patients with rheumatologic disease are direct manifestations of those conditions. And the impression that cutaneous lupus represents less severe disease may be mistaken.
