From the Guidelines
Managing facial flushing in patients with Systemic Lupus Erythematosus (SLE) primarily involves optimizing SLE treatment with antimalarials and immunosuppressants, alongside avoiding triggers and using topical treatments for symptom relief. The approach to managing facial flushing in SLE patients should prioritize minimizing disease activity and controlling symptoms. According to the 2019 update of the EULAR recommendations for the management of SLE 1, the goals of treatment include achieving remission or low disease activity and preventing flares in all organs, which can help reduce the occurrence of facial flushing.
Key considerations for managing SLE and its symptoms like facial flushing include:
- Optimizing SLE management with antimalarials like hydroxychloroquine (HCQ), which is recommended for all patients with SLE unless contraindicated, at a dose not exceeding 5 mg/kg/real body weight 1.
- Identifying and avoiding triggers such as sun exposure, hot beverages, spicy foods, alcohol, and extreme temperatures.
- Using sun protection measures including broad-spectrum SPF 50+ sunscreen, wide-brimmed hats, and UV-protective clothing.
- Topical treatments for symptom management, such as green-tinted primers, mild corticosteroids for acute flares, and calcineurin inhibitors for longer-term management.
For moderate to severe flushing, considerations may include oral medications like low-dose doxycycline for its anti-inflammatory effects or, in select cases, low-dose propranolol for its ability to reduce vascular reactivity 1. It's also important to address the underlying inflammation and vascular reactivity that contribute to facial flushing in SLE patients.
Given the recommendations for SLE management and the importance of controlling disease activity, the most effective approach to managing facial flushing in SLE patients involves a combination of optimized SLE treatment, trigger avoidance, and targeted symptom relief measures. This comprehensive strategy can help improve outcomes for patients with SLE experiencing facial flushing, focusing on reducing morbidity, mortality, and enhancing quality of life.
From the Research
Managing Facial Flushing in SLE Patients
- Facial flushing is a common symptom in patients with Systemic Lupus Erythematosus (SLE) 2
- Cutaneous manifestations of SLE, including facial flushing, can be managed with various treatments, including hydroxychloroquine and immunosuppressants 3, 4
Treatment Options
- Hydroxychloroquine is considered an anchor drug in SLE treatment and should be considered for all patients, including those with facial flushing 3, 4, 5
- Immunosuppressants, such as azathioprine and mycophenolate mofetil, may be prescribed for patients with persistent disease activity despite hydroxychloroquine therapy 3
- Biologic agents, such as belimumab and rituximab, may be used in SLE management, including for patients with facial flushing 4
Case Studies
- A study of three SLE patients treated with initial hydroxychloroquine monotherapy showed reduced disease activity and no new SLE symptoms emerged 5
- Another study presented two patients with facial eruptions associated with SLE, highlighting the importance of investigating atypical or treatment-resistant eruptions 2