Derm

Cutaneous Lupus Erythematosus

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Cutaneous Lupus Erythematosus, Cutaneous Lupus, Discoid Lupus Erythematosus, Discoid Lupus, Chronic Cutaneous Lupus, Scarring Discoid Lupus, Subacute Cutaneous Lupus, Acute Cutaneous Lupus, CLE, CCLE, SCLE, ALE

  • Classification
  1. Chronic Cutaneous Lupus (CCLE) or Discoid Lupus (DLE)
    1. Peak Incidence in ages 30 to 40 years
    2. More common in women
    3. Exacerbated by Trauma and sunlight
    4. Asymmetric red 1-2 cm Plaques with adherent scale
      1. Progresses to local skin atrophy over months
      2. Ultimately results in scar
        1. Scar with altered pigmentation
        2. Usually depressed, but may be hypertrophic
  2. Subacute Cutaneous Lupus (SCLE)
    1. Mid-category between CCLE and ALE
    2. Usually heals without scarring (unlike CCLE)
    3. Annular Lesion
      1. Usually involves mid-trunk
      2. Central Hypopigmentation and telangiectasia
  3. Acute Cutaneous Lupus (ALE)
    1. Red Plaques
      1. Occurs on face, chest, and Shoulders
      2. Extensor arm and hand dorsum also involved
    2. Malar Rash may also occur
  • Labs
  1. Skin Biopsy
    1. Consider ordering immunofluorescence for older lesion
  2. Serologic testing if biopsy suggests Cutaneous Lupus
    1. ANA titer (positive if 1:160 or higher)
      1. Chronic Cutaneous Lupus (CCLE): 4%
      2. Subacute Cutaneous Lupus (SCLE): 63%
      3. Acute Cutaneous Lupus (ALE): 98%
    2. Anti-dsDNA
      1. Subacute Cutaneous Lupus (SCLE): 30%
      2. Acute Cutaneous Lupus (ALE): 60-80%
    3. Complement (C3 or CH50)
      1. Suppressed in 90% of Acute Cutaneous Lupus (ALE)
  3. Further evaluation
    1. See Systemic Lupus Erythematosus
    2. Distinguish systemic from isolated skin involvement
  • Management
  1. Sunscreen with UVA and UVB protection is critical
  2. Topical Corticosteroids (first choice)
  3. Intralesional Corticosteroid
    1. Indicated for Discoid Lupus (DLE, CCLE)
  4. Systemic agents
    1. First-line: Hydroxychloroquine (Plaquenil)
    2. Other agents (if refractory to topicals, Plaquenil)
      1. Dapsone
      2. Oral Corticosteroids
      3. Azathioprine
      4. Isotretinoin
      5. Methotrexate
  • References
  1. Habif (1996) Dermatology, p. 544-9
  2. Patel (2002) Dermatol Clin 20(3):373-85 [PubMed]