Objective Cutaneous vasculitis (CV) is a rare manifestation of systemic lupus erythematosus (SLE). The aim of this study was to determine differences in clinical and laboratory characteristics of CV patients with active versus inactive SLE.

Methods Nine patients with a diagnosis of SLE confirmed by rheumatology and dermatology who had biopsy-proven CV between 2015–2022 at a single institution were identified for retrospective chart review. Active SLE (ASLE) indicates symptomatic SLE. Inactive SLE (ISLE) indicates that SLE is in remission.

Results Three patients had ASLE, and six patients had ISLE. Clinical manifestations of CV include palpable purpura, ulcers, and urticarial lesions. CV in patients with ASLE presented within 1 year of initial SLE diagnosis, whereas CV in ISLE presented later than 1 year after initial SLE diagnosis. 66.7% of ASLE patients required a total of three or more immunosuppressive medications; this was also true for 66.7% of ISLE patients. Serologic findings and blood counts were not found to be correlated with SLE activity or presence of CV. 100% of ASLE patients had hypocomplementemia, compared to 50% of ISLE patients. Complements were not predictive of CV in ISLE patients except for those with urticarial vasculitis on biopsy.

Conclusion CV can concomitantly occur in ASLE but may also develop when SLE is in remission. In patients with a history of SLE, CV often requires aggressive immunosuppressive treatment regardless of SLE activity. Larger-scale prospective studies are necessary to confirm findings.

Acknowledgements This study was approved by the Institutional Review Board of the Ohio State University (#2023E0607) and supported by Award #UL1TR002733 from the National Center for Advancing Translational Sciences (NCATS). The content is solely the responsibility of the authors and does not necessarily represent the official views of NCATS or the National Institutes of Health.