The Cutaneous Lupus Erythematosus Disease Activity and Severity Index: expansion for rheumatology and dermatology

OBJECTIVE

To evaluate the validity of the Cutaneous Lupus Erythematosus Disease Area and Severity Index (CLASI) for use by rheumatologists via reliability testing, and to extend the validation for dermatologists.

METHODS

Fourteen subjects with cutaneous lupus erythematosus (CLE; n = 10), a mimicker skin disease only (a cutaneous lesion that may appear clinically similar to CLE; n = 1), or both (n = 3) were rated with the CLASI by academic-based dermatologists (n = 5) and rheumatologists (n = 5).

RESULTS

The dermatology intraclass correlation coefficient (ICC) was 0.92 for activity and 0.82 for damage; for rheumatology the ICC was 0.83 for activity and 0.86 for damage. For intrarater reliability, the dermatology Spearman's rho was 0.94 for activity and 0.97 for damage; for rheumatology the Spearman's rho was 0.91 for activity and 0.99 for damage.

CONCLUSION

Our data confirm the reliability of the CLASI when used by dermatologists and support the CLASI as a reliable instrument for use by rheumatologists.

Epidermal growth factor, estrogen, and progesterone receptor expression in primary sweat gland carcinomas and primary and metastatic mammary carcinomas

The distinction between primary sweat gland carcinomas and metastatic breast carcinoma to the skin is sometimes difficult. In an effort to improve this discrimination, we compared the immunohistochemical staining pattern of 42 primary sweat gland carcinomas (SGCs) with 30 metastases from breast carcinoma (BC) to the skin, 125 primary BCs, and 30 noncutaneous metastases from BCs. The antibodies used were against the receptors for epidermal growth factor (EGF-R), estrogen receptor (ER), and progesterone receptor (PR). The frequencies of positive staining were as follows for EGF-R: 34 (81%) of 42 SGCs, 5 (17%) of 30 BCs metastatic to skin, 28 (22%) of 125 primary BCs, and 6 (20%) of 30 noncutaneous BC metastases. For ER, the frequencies were 9 (21%) of 42 SGCs and 10 (33%) of 30 BCs metastatic to skin. The frequencies for PR were 8 (19%) of 42 SGCs and 8 (27%) of 30 BCs metastatic to skin. These results suggest that expression of EGF-R may be diagnostically helpful, because it is strongly associated with SGCs when compared with metastatic BCs (P < .0001). This association is also present when ductal eccrine and apocrine types of SGC, which are the histologic subtypes of SGC most difficult to distinguish from metastatic BC, are separately analyzed (P < .001). The frequencies of expression of ER and PR in SGCs and BCs metastatic to skin were not significantly different.