The cutaneous lupus erythematosus disease area and severity index: a responsive instrument to measure activity and damage in patients with cutaneous lupus erythematosus.

Department of Dermatology, University of Pennsylvania, 2 Rhodes Pavilion, 3600 Spruce St, Philadelphia, PA 19119, USA.
Archives of dermatology (Impact Factor: 4.31). 03/2008; 144(2):173-80. DOI: 10.1001/archderm.144.2.173
Source: PubMed

ABSTRACT To assess the clinical responsiveness of the CLASI (Cutaneous Lupus Erythematosus [CLE] Disease Area and Severity Index).
Validation cohort.
Tertiary referral center. Patients Eight patients with CLE. Intervention Assessment of patients with CLE from baseline until day 56 after starting a new standard of care therapy.
Correlation of the baseline to day-56 change in 2 CLASI scales (disease activity and damage), with baseline to day-56 change in the physicians' and patients' assessments of patient's global skin health scores, and the patients' assessments of pain and itch.
The change in CLASI activity score highly correlated with the changes in 3 clinical validation measures: physicians' assessment of skin health (r = 0.97; P = .003; n = 7), patients' global skin health score (r = 0.85; P = .007; n = 8), and pain (r = 0.98; P = .004; n = 5). Using the Wilcoxon signed-rank test, paired baseline to day-56 changes in CLASI activity and damage scores were analyzed for the 2 subgroups (meaningful change vs nonmeaningful change) composing each validation variable. Change in CLASI activity was significantly different for patients who had a meaningful change in their global skin self-ratings (Z = 1.07; P = .03) and approached statistical significance for patients who had a meaningful change in their level of itching (Z = 1.83; P = .06) and their physicians' global skin rating (Z = 1.84; P = .06). The CLASI activity score decreases after successful therapeutic intervention, whereas the damage score may increase in scarring forms of CLE. Conclusion The activity score of the CLASI correlates with the improvement of global skin health, pain, and itch and is thus a useful tool to measure clinical response.

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    ABSTRACT: The quality of life (QOL) of lupus erythematosus (LE) patients with skin manifestations is impaired, but little is known about Japanese patients. We assessed whether the skin symptoms in LE are associated with the QOL using the Japanese versions of the Skindex-29 and Cutaneous Lupus Erythematosus Disease Area and Severity Index (CLASI). In all, 54 LE patients with cutaneous lesions completed the Japanese version of the Skindex-29, and physicians assessed the severity of their eruptions using the CLASI before and after treatment. The QOL of the LE patients was better after the therapeutic intervention using the Skindex-29 questionnaire. We tested several factors for an independent association with the QOL. A significant risk factor for a poor QOL was a female gender in "Functioning" before treatment. In addition, a poor QOL tended to be correlated with a female gender in "Emotions" and older current age in "Symptoms" before treatment, and with a longer duration of SLE in "Functioning" after treatment. In the CLASI analysis, skin manifestation activity in the acute phase correlated with a poor emotional and functional QOL rather than a symptomatic QOL. To the best of our knowledge, this is the first report evaluating the QOL of Japanese LE patients, despite the small cohort.
    Lupus 11/2013; 23(1). DOI:10.1177/0961203313509293 · 2.48 Impact Factor
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    ABSTRACT: Background In the last years, it has been controversially discussed in the literature if smoking is associated with the activity of cutaneous lupus erythematosus (CLE) and the efficacy of antimalarial agents.Objectives To investigate the influence of smoking on disease severity and antimalarial treatment in patients with CLE using the Core Set Questionnaire of the European Society of Cutaneous Lupus Erythematosus (EUSCLE).MethodsA total of 1002 patients (768 female, 234 male) with different CLE subtypes were included in this cross-sectional study, which was performed in 14 different countries. Smoking behaviour was assessed by the EUSCLE Core Set Questionnaire and statistically analysed using an SPSS database. The results were correlated with the Cutaneous Lupus Erythematosus Disease Area and Severity Index (CLASI) and the efficacy of antimalarial treatment.ResultsA high percentage (87.2%) of the 499 CLE patients, who have ever smoked, had already smoked by the date of their first diagnosis. Patients with intermittent CLE smoked significantly more often than patients with subacute CLE (p<0.05) and chronic CLE (p<0.05). The total CLASI activity and damage score of CLE patients was 6.6 ± 7.1 and 2.6 ± 4.3, respectively, and was higher in patients who have ever smoked than in non-smokers. Antimalarial treatment was successful in 84.3% of cases, with a significantly higher efficacy in non-smokers than in patients who have ever smoked (p<0.05). The total CLASI activity score was lower in CLE patients treated with antimalarials at the time point of the evaluation compared to untreated patients.Conclusion This multicentre analysis of 1002 CLE patients assessed by the EUSCLE Core Set Questionnaire statistically confirms that smoking influences CLE disease severity and the efficacy of antimalarial treatment.This article is protected by copyright. All rights reserved.
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    ABSTRACT: Background and objectives The study of quality of life in patients with skin disorders has become more important in recent decades. In the case of lupus erythematosus, most quality-of-life studies have focused on the systemic form of the disease, with less attention being paid to the cutaneous form. The main objective of this study was to evaluate quality of life in patients with cutaneous lupus erythematosus (CLE) using a dermatology-specific questionnaire: the Dermatology Life Quality Index (DLQI). Our secondary objective was to investigate associations between DLQI scores and other aspects of the disease. Material and methods Thirty-six patients with CLE completed the DLQI questionnaire. Other factors assessed were disease severity (measured using the Cutaneous Lupus Erythematosus Disease Area and Severity Index), time since diagnosis, body surface area affected, previous and current treatments, and the presence of criteria for systemic lupus erythematosus (SLE). Results According to the DLQI, CLE had a moderate, very large, or extremely large effect on quality of life in 50% of the patients analyzed (18/36). No significant associations were found between DLQI scores and disease severity, time since diagnosis, body surface area affected, number, type, or duration of pharmacologic treatments, or the presence or absence of SLE criteria. Conclusion CLE has a significant and lasting effect on patient quality of life. This effect is probably primarily due to multiple factors, including the chronic nature of the disease, the visibility of the lesions, and the fact that they can cause disfigurement.
    Actas Dermo-Sifiliográficas 11/2013; 104(9):800–806. DOI:10.1016/

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