From the Guidelines
Lupus rash treatment should prioritize hydroxychloroquine (HCQ) at a dose not exceeding 5 mg/kg real body weight, as recommended by the 2019 EULAR guidelines 1.
Treatment Overview
A lupus rash, also known as a malar or butterfly rash, is a characteristic skin manifestation of systemic lupus erythematosus (SLE). This rash typically appears as a red, raised rash across the cheeks and bridge of the nose in a butterfly pattern.
Key Recommendations
- First-line treatment for skin disease in SLE includes topical agents (GC, calcineurin inhibitors), antimalarials (HCQ, quinacrine), and/or systemic GC 1.
- Hydroxychloroquine (HCQ) is recommended for all patients with SLE, at a dose not exceeding 5 mg/kg real body weight, unless contraindicated 1.
- Sun protection is essential, using broad-spectrum SPF 50+ sunscreen daily, wearing protective clothing, and avoiding peak sun hours (10am-4pm) 1.
- Gentle skincare with fragrance-free products helps prevent irritation.
Additional Considerations
- For more severe cases, oral medications such as hydroxychloroquine (200-400mg daily) may be prescribed.
- In non-responsive cases or cases requiring high-dose GC, methotrexate, retinoids, dapsone, or mycophenolate can be added 1.
- The rash occurs due to autoimmune inflammation where the body's immune system attacks healthy skin cells, often triggered by UV light exposure.
- If you notice this distinctive rash, seek medical evaluation promptly as it may indicate active lupus requiring systemic treatment beyond just addressing the skin symptoms.
From the FDA Drug Label
1.3 Systemic Lupus Erythematosus Hydroxychloroquine sulfate tablets are indicated for the treatment of systemic lupus erythematosus in adults.
1.4 Chronic Discoid Lupus Erythematosus Hydroxychloroquine sulfate tablets are indicated for the treatment of chronic discoid lupus erythematosus in adults.
2.4 Dosage for Systemic Lupus Erythematosus in Adults The recommended dosage is 200 mg given once daily, or 400 mg given once daily or in two divided doses.
2.5 Dosage for Chronic Discoid Lupus Erythematosus in Adults The recommended dosage is 200 mg given once daily, or 400 mg given once daily or in two divided doses.
Lupus Rash Treatment: Hydroxychloroquine sulfate tablets are indicated for the treatment of systemic lupus erythematosus and chronic discoid lupus erythematosus in adults, which may include the treatment of lupus rash. The recommended dosage for these conditions is 200 mg given once daily, or 400 mg given once daily or in two divided doses 2.
From the Research
Lupus Rash Overview
- Lupus rash, also known as cutaneous lupus erythematosus (CLE), is an inflammatory, autoimmune disease that encompasses a broad spectrum of subtypes, including acute, subacute, chronic, and intermittent CLE 3.
- The diagnosis of CLE is mainly based on the evaluation of clinical and histopathological manifestations, with an exclusion of systemic lupus erythematosus (SLE) by assessment of systemic involvement 3.
Treatment Options
- Topical corticosteroids and topical calcineurin inhibitors are first-line treatments for localized CLE lesions 3.
- For widespread or severe CLE lesions, and/or cases resistant to topical treatment, systemic treatment including antimalarials and/or short-term corticosteroids can be added 3.
- Antimalarials, such as hydroxychloroquine, are the first-line systemic treatment for all types of CLE and can also be used in pregnant patients and pediatric patients 3, 4, 5.
- Other treatment options include thalidomide, retinoids, dapsone, and methotrexate (MTX) as second-line choices, and mycophenolate mofetil (MMF) as third-line treatment 3.
- Biologic therapies, such as belimumab, may be used as fourth-line treatment for widespread CLE lesions in patients with active SLE 3, 6.
Management and Prevention
- Patient education and long-term follow-up are necessary for the management of CLE 3.
- Disease activity, damage of skin and other organs, quality of life, comorbidities, and possible adverse events should be assessed in every follow-up visit 3.
- Sun protection measures, smoking cessation, and optimization of vitamin D levels are general measures to be considered in the management of CLE 6.
- Topical tacrolimus may be a useful alternative for treating the malar rash of SLE, especially in patients who cannot tolerate topical corticosteroids 7.