Aspectos clínicos e histopatológicos do lúpus eritematoso cutâneo registrados em serviço de referência do estado do Pará no período de 2010 a 2017

Abstract

INTRODUCTION: Systemic Lupus erythematosus (SLE) is an autoimmune and multifactorial disease characterized by a chronic inflammatory process resulting from changes in immune regulation due to the production of autoantibodies against various cellular constituents. The skin is one of the target organs most affected by the disease, and genetic, hormonal and environmental factors interact and interfere with the development of skin disease. The cutaneous manifestations can be divided into specific and nonspecific, according to their clinical and histological characteristics, and the specific ones can be found in the skin in three ways: chronic (CCLE) ; Subacute (SCLE) and Acute (ACLE). It presents genetic, autoimmune, hormonal and environmental factors as pathogenic substrates, and its clinical and laboratory characteristics help the diagnosis, which can be confirmed by histopathological study. OBJECTIVES: This study aims to elucidate the histopathological changes that occur in the LECC and its subtypes, correlating the disorders analyzed in the slides with the clinical manifestations presented by the patient. MATERIAL AND METHODS: This was a cross-sectional, retrospective and descriptive study conducted at the dermatology service of the Federal University of Pará through the analysis of medical records in which the disease was histologically confirmed. RESULTS: We analyzed epidemiological and clinical data from a group of 55 patients with Cutaneous lupus erythematosus (CLE) . The average age at disease onset was 42 years. There was a predominance of females (80% of cases). 64% of the cases affected the face, and 51% were disseminated or generalized in the skin (with lesions also below the neck). There was a predominance of erythema and peeling (87% and 47% of cases), followed by atrophy (42%). The most affected phototype was IV in 61.8% of cases. 33% of the cases were CCLE, followed by ACLE in 13 patients (24%) and SCLE in four patients (7%). The most frequent dermatological lesion was erythema (87%), followed by scaling, infiltration and atrophy. 29% of patients had positive antinuclear factor. In the epidermis it was observed that all cases presented vacuolar alteration, 64% of patients presented basal thickening and 58% atrophy. In the dermis, all patients presented lymphocytes in the infiltrate and 87% presented mucin in the connective interstices. CONCLUSION: Understanding the changes that appear at the microscopic level is of paramount importance for understanding the course of the disease and, thus, enabling the elaboration of an appropriate therapeutic approach. The medical professional plays a fundamental role in the management of patients with Cutaneous lupus erythematosus, and their duty is to understand all its universality for a satisfactory clinical follow-up and the prevention of possible injuries. Although not a common disease, its chronicity leads to the accumulation of cases in clinical outpatient clinics. In addition, although progress is good in most cases, delayed initiation of treatment can lead to disfiguring scars.