Late-onset cutaneous lupus erythematosus patients have distinctive clinical features and demographics versus early-onset patients

Abstract

Background Cutaneous lupus erythematosus (CLE) can present later in life, but frequency and risk factors of late-onset CLE patients are not well characterized. The study determined frequency of late-onset CLE and compared the demographic and disease characteristics between early-onset and late-onset CLE in a cohort of patients with CLE. Objectives To determine the frequency and compare clinical features of early-onset and late-onset CLE. Methods This was a cross-sectional study of CLE patients seen in outpatient dermatology clinics at University of Texas Southwestern Medical Center (UTSW) and Parkland Health and Hospital System, Dallas, TX, from April 2009 to May 2019. The primary outcome was the age of CLE onset, stratified by early-onset (<50 years) and late-onset CLE (≥50 years). Predictor variables significantly associated with CLE onset groups were identified by univariate and multivariable logistic regression analyses. Results Of the 291 CLE patients studied, 79% were early-onset, and 21% were late-onset. Multivariable logistic regression analyses identified that Caucasian race (odds ratio (OR): 2.23, 95% Confidence Interval (CI): 1.19–4.19, p = 0.013), having a CLE subtype other than chronic (OR: 2.18, 95% CI: 1.02–4.65, p = 0.044), and drug-induced cases (OR: 4.65, 95% CI: 1.18–18.24, p = 0.028) were significantly associated with late-onset CLE. Early-onset CLE patients were more likely to have oral ulcers (OR: 3.58, 95% CI: 1.46–8.78, p = 0.005) and renal disorders (OR: 4.02, 95% CI: 1.10–14.71, p = 0.036). Limitations This was a single center study. Age of onset was self-reported and late-onset CLE cohort has a small sample size. Conclusions Our diverse cohort of CLE patients had about one out of five patients with CLE experiencing disease onset after 50 years old. These patients have distinct demographic and clinical presentations compared to early-onset CLE patients. Providers should remain mindful of CLE in older patients with photosensitive rashes and mild systemic symptoms.