Title : Keratinocyte apoptosis by caspase – 3 Immunostaining in histopathology as marker of activity as well as correlation with dermoscopy findings in Cutaneous Lupus Erythematosus (CLE) in skin of color: An observational study.
Abstract:
Background: Keratinocyte apoptosis is involved in pathogenesis of CLE, but the same as a marker of disease activity is not established in literature.
Aim & Objective: To correlate keratinocyte apoptosis stained with Caspase 3 immunostaining with R-CLASI activity (R-CLASI-A) score and dermoscopic findings as marker of activity in CLE.
Materials & Methods: In 45 patients with CLE, R-CLASI-A was measured, dermoscopy was done for the most active lesion and biopsy taken. Biopsy was stained with Caspase 3 and Keratinocyte Apoptotic Index [ KAI], and Apoptosis Intensity Score [AIS] were calculated.
Results: The average KAI of DLE (n = 28), SCLE (n = 8) and ACLE (n = 9) were 2.71 ± 1.32, 3.83 ± 0.89 and 2.56 ± 1.09 (p = 0.038), while AIS were 5.63 ± 3.65(DLE), 8.96 ± 2.1(SCLE), 5.4 ± 4.3(ACLE) (p = 0.005). The average R-CLASI-A score of these three subgroups were 22.04 ± 15.82(DLE), 32.75 ± 17.58(SCLE) and 34.44 ± 22.16(ACLE) respectively. the average KAI and AIS of two patients of disseminated DLE with SLE was 5.16, which was higher than localized and disseminated DLE patients without SLE. Correlation showed positive correlation between KAI and R-CLASI-A in DLE (r = 0.38, p = 0.046) and ACLE (r = 0.81, p = 0.009) but negative correlation in SCLE (r = -0.73, p = 0.042). Positive correlations were seen between linear non-branched, non-curved vessels and AIS in DLE (r = 0.43, p = 0.023) and negative correlation with perifollicular white color (r = 0.39, p = 0.04) in DLE. Similarly, SCLE showed positive correlation between presence of scales (r = 0.82, p = 0.012) and patchy scales (r = 0.82, p = 0.012) with AIS.
Conclusion: Higher lesional KAI and AIS, but significant negative correlation with-R-CLASI-A in SCLE suggests that decreased KAI and AIS in SCLE can predict higher activity of disease, future relapse of disease and can be used as a monitoring tool of disease activity. Similarly, Higher KAI and AIS in those patients of SLE presenting with disseminated DLE as the main cutaneous findings can be correlated with different clinical presentations from the patients of disseminated DLE who do not have any systemic involvement and guide clinician for evaluation at priority to evade systemic involvement. Similarly, Dermoscopy findings correlated with R-CLASI-A score, KAI and AIS can be considered specific markers of activity of disease and help physicians to intervene to stop systemic involvement.
Limitation: Limited time span causing small sample size in each group.
