From the Guidelines
Cutaneous Lupus (Systemic Lupus Erythematosus - SLE) skin lesions are characterized by LE-specific and LE-non-specific lesions, including acute cutaneous LE (CLE), subacute CLE, chronic CLE, and intermittent CLE, which can be difficult to diagnose and may require evaluation by an experienced dermatologist and a skin biopsy for histological analysis. The diagnosis and management of these lesions should be guided by the most recent and highest quality evidence, which emphasizes the importance of photoprotection, patient education, and self-management support in preventing flares and improving health-related quality of life (HRQoL) 1.
Characteristics of Cutaneous Lupus Lesions
- LE-specific lesions: acute cutaneous LE (CLE), subacute CLE, chronic CLE, and intermittent CLE
- LE-non-specific lesions: may mimic other conditions and require evaluation by an experienced dermatologist and a skin biopsy for histological analysis
- Diagnosis: may be difficult and require repeat biopsy if there is a change in the clinical morphology of the lesions or if there is a lack of response to treatment
Management of Cutaneous Lupus Lesions
- Photoprotection: broad-spectrum sunscreen (SPF 50+) daily, use protective clothing, and avoid peak sun hours to prevent flares 1
- Patient education and self-management support: important for improving HRQoL and preventing flares
- Topical treatments: may include topical corticosteroids and calcineurin inhibitors
- Systemic medications: may include antimalarial medications, such as hydroxychloroquine, and immunosuppressants, such as methotrexate and mycophenolate mofetil
Monitoring and Follow-up
- Regular skin examinations: important to monitor treatment response and detect any new lesions early
- Repeat biopsy: may be necessary if there is a change in the clinical morphology of the lesions or if there is a lack of response to treatment
- Assessment of HRQoL: important to evaluate the impact of cutaneous lupus lesions on patient quality of life and to guide management decisions 1
From the Research
Characteristics of Cutaneous Lupus (Systemic Lupus Erythematosus - SLE) Skin Lesions
- Cutaneous lupus erythematosus (CLE) is an inflammatory, autoimmune disease encompassing a broad spectrum of subtypes including acute, subacute, chronic and intermittent CLE 2
- Chronic CLE can be further classified into several subclasses of lupus erythematosus (LE) such as discoid LE, verrucous LE, LE profundus, chilblain LE and Blaschko linear LE 2
- The specific skin lesions that are most common are discoid lupus erythematosus (DLE) and subacute cutaneous lupus erythematosus (SCLE) 3
- Cutaneous lesions can generally be managed with standard therapies, and patients with discoid LE and subacute cutaneous LE are generally photosensitive 3
Clinical Manifestations
- Diagnosis of CLE is mainly based on the evaluation of clinical and histopathological manifestations, with an exclusion of SLE by assessment of systemic involvement 2
- Skin disease in patients with lupus erythematosus may be subdivided into two broad categories - those represented by a 'specific' histopathology, the interface dermatitis, and those with changes that are not specific to lupus erythematosus 3
- Cutaneous lupus erythematosus (CLE) is a rare inflammatory autoimmune disease with heterogeneous clinical manifestations 4
Treatment Options
- Topical corticosteroids and topical calcineurin inhibitors are first-line treatment for localized CLE lesions 2, 4
- Antimalarials are the first-line systemic treatment for all types of CLE, and can also be used in pregnant patients and pediatric patients 2, 4
- Systemic corticosteroids are recommended as first-line treatment in highly active and/or severe CLE 4
- Second- and third-line systemic treatments include methotrexate, retinoids, dapsone and mycophenolate mofetil or mycophenolate acid 2, 4