Persistence of Racial Disparities in the Diagnosis of Lupus Panniculitis Despite Favorable Factors for Diagnosis

Camila Villa, MPH
Department of Dermatology
Poster Overview

Lupus erythematosus panniculitis (LEP) is a rare variant of lupus erythematosus that affects the skin and subcutaneous tissue. LEP can coexist with other lupus variants such as systemic lupus erythematosus and discoid lupus erythematosus or occur as an isolated entity. Cutaneous lupus is known to disproportionately affect patients with darker skin types. Thus, we aimed to investigate racial disparities in LEP in black and Hispanic patients.

We confirmed 61 cases of LEP in three academic centers, 23 of which were black or Hispanic. When compared to their white counterparts, black and Hispanic patients were at higher risk of coexisting SLE and/or DLE. Given the rarity of LEP, we hypothesized that a prior diagnosis of SLE or DLE would aid physicians in diagnosing this rare entity. Nevertheless, despite higher rates of pre-existing lupus variants such as SLE and DLE, black and Hispanic patients experienced a 49.6-month delay in diagnosis; that is, a 41.3-month greater delay than their white counterparts. Thus, our data suggests that racial disparities in the diagnosis of LEP persist even in the presence of favorable factors for diagnosis such as pre-existing SLE or DLE.

Scientific Abstract

Lupus erythematosus panniculitis (LEP) is a variant of lupus erythematosus that can coexist with systemic lupus erythematosus (SLE) or discoid lupus erythematosus (DLE), or can occur as an isolated entity. Given that cutaneous lupus variants are thought to disproportionately impact patients with darker skin types, this study aimed to investigate the racial disparities in LEP in black and Hispanic patients.

We conducted a retrospective chart review of 5,717 patients diagnosed with cutaneous lupus at Brigham and Women’s Hospital, Massachusetts General Hospital, and New York University Langone Medical Center and confirmed 61 cases of LEP.

Of 61 patients with LEP, 23 (38%) were black or Hispanic. Compared to their white counterparts with LEP, whose frequency of concomitant SLE and DLE was 7/24 (29%) and 5/24 (21%), respectively, the black and Hispanic population showed a higher percentage of both concurrent SLE, with 9/23 (39%) and DLE, with 15/23 (65%) patients. We hypothesized that a prior diagnosis of SLE and/or DLE would decrease the delay in diagnosis that is frequently seen in LEP. However, despite a higher frequency of concurrent SLE and/or DLE, black and Hispanic patients with preexisting lupus variants had a 49.6-month delay in diagnosis; that is, a 41.3- month greater delay than white patients with SLE or DLE. Thus, this data suggests that racial disparities in time to diagnosis persist despite favorable factors for diagnosis.

Clinical Implications
1.) To highlight the rates of comorbid SLE/DLE in lupus erythematosus panniculitis. 2.) To raise awareness of the racial disparities in cutaneous lupus variants. 3.) To emphasize the high burden of comorbid SLE/DLE in black and Hispanic patients with lupus panniculitis.
Research Areas
Authors
Camila Villa-Ruiz, MPH;Lauren K. Rangel, BA; Kelly Lo, BS; Gabriela Cobos, MD; Alisa Femia, MD; Ruth Ann Vleugels, MD, MPH.
Principal Investigator
Ruth Ann Vleugels, MD, MPH

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