S2k guideline: Diagnosis and management of cutaneous lupus erythematosus – Part 2: Therapy, risk factors and other special topics

Abstract

Topical treatment Topical glucocorticoidsClass 2-4 topical glucocorticoids are the treatment of choice for cutaneous lupus erythematosus (CLE). A randomized, controlled study has shown that fluocinonide 0.05 % is more effective than hydrocortisone 1 % [1]. Class 4 topical glucocorticoids are indicated for lesions on the capillitium, the palms of the hands/soles of the feet, and for hyperkeratotic lesions, covered by a foil/hydrocolloid dressing where required. Strictly intralesional injections of triamcinolone acetonide may be considered in individual cases, and this may be repeated after 4-6 weeks as needed. Side effects with use over longer periods of time are a limiting factor, so either short-term use over a period of several weeks, or interval treatment is recommended. Recommendation Strength AgreementTopical glucocorticoids are recommended for treating circumscribed CLE lesions.

Lupus erythematosus

“…All patients who do not respond adequately to these or have more pronounced involvement should be switched to hydroxychloroquine. 2 This preparation interferes with recognition of nucleic acids by the innate immune system and thereby reduces inflammatory activity. It is very effective in most forms of lupus and is generally well tolerated.…”

“…Unfortunately, apart from mepacrine, which can be ordered via the international pharmacy, no other alternative antimalarial drugs are currently available. 2 This is problematic for patients who cannot tolerate the drug. Such individuals and patients with an insufficient response to hydroxychloroquine can receive therapy with methotrexate (MTX).…”

Lupus erythematodes

“…Aber auch subakute Formen des kutanen Lupus und das Spektrum des chronischen kutanen Lupus können mit dem SLE assoziiert sein, weshalb Screening-Untersuchungen zum Ausschluss einer Systemmanifestation bei jedem Patienten mit kutanen Lupus erforderlich sind und vor allem bei Risikopatienten wie jungen Frauen, regelmäßig wiederholt werden sollten. 2 Zur Klassifikation eines SLE sind die ACR-Kriterien hilfreich, die in den letzten Jahren überarbeitet wurden. 3 Hautveränderungen können als akute, diskoide oder subakut kutane Formen mit maximal 6 von 10 Punkten in die Kalkulation einfließen.…”

“…Die therapeutischen Möglichkeiten des LE und insbesondere des kutanen LE sind nach wie vor sehr begrenzt, nur symptomatisch möglich und von begrenzter Wirksamkeit. 2 Sie basieren im Wesentlichen auf der Vermeidung der Exposition gegenüber auslösenden Faktoren durch Sonnen-und Kälteschutz sowie Nikotinkarenz. Lokalisierte Formen des Hautlupus werden mit topischen Steroiden behandelt.…”

The role of histopathology in a case of adult‐onset linear cutaneous lupus

“…Based on these findings we diagnosed a Blaschko-linear, chronic cutaneous Lupus erythematodes (LE), also known as linear cutaneous LE (LCLE) and established a therapy with hydroxychloroquine 200 mg and topical tacrolimus once daily. 1,2 This led to a significant improvement of skin inflammation with residual atrophic scars after 6 months of treatment (Figure 2). Linear cutaneous LE was first described in 1978.…”