Cutaneous lupus erythematosus: A personal approach to management

Abstract

SUMMARY Skin disease in patients with lupus erythematosus may be subdivided into two broad categories - those lesions that when biopsied demonstrate interface dermatitis and those that do not demonstrate interface dermatitis. The skin lesions that are represented by the interface dermatitis include discoid lupus erythematosus, subacute cutaneous lupus erythematosus and acute cutaneous lupus erythematosus. Patients with these 'specific' manifestations have varying degrees of systemic involvement from rare systemic disease in patients with localized discoid lupus erythematosus to common and often severe involvement in patients with acute cutaneous lupus erythematosus. Patients who do not demonstrate interface dermatitis also may have systemic disease and in some instances the skin manifestations are linked to some of the more severe systemic manifestations. Many patients with cutaneous lesions characterized by the interface dermatitis can be controlled with 'standard' therapies including sunscreens, protective clothing and behavioural alteration, and topical corticosteroids with or without an oral antimalarial agent. This review presents a brief summary of each common cutaneous manifestation of lupus erythematosus, its relationship to systemic involvement and treatment issues to effectively deal with the lupus erythematosus patient who has skin disease.

Early Diagnosis and Treatment of Discoid Lupus Erythematosus

“…Recognized side effects of intralesional steroids include cutaneous atrophy and dyspigmentation, which are not significant risks in experienced hands. 13 Oral steroids may be required for the control of systemic lupus but are not generally beneficial in DLE. For patients with progressive or disseminated disease or in those with localized disease that does not respond to topical measures, the addition of systemic agents should be considered.…”

Primary Cicatricial Alopecia

“…Recurrences are usually seen in formerly affected scars. Systemic lupus erythematosus develops in about 5%-10% of adults, usually within 1-3 years of diagnosis [29]. Adults with widespread disease and affected children (26%-31%) may be particularly prone [29,145].…”

“…Systemic lupus erythematosus develops in about 5%-10% of adults, usually within 1-3 years of diagnosis [29]. Adults with widespread disease and affected children (26%-31%) may be particularly prone [29,145]. Complications of DLE include ulceration and development of secondary squamous cell carcinoma that can be life-threatening if left unchecked.…”

“…Sun-protective measures should be reviewed. Smoking should be discouraged, or at least lessened [29]. Scratching, picking, and traumatic hairgrooming practices should be minimized because of the potential risk of koebnerization.…”

“…Discoid lupus erythematosus that is rapidly advancing, extensive, disfiguring or refractory to topical treatment requires the use of a systemic agent [29,145]. Antimalarials are first line, and often highly effective.…”