Cutaneous Lupus Symptoms and Treatments

CLE occurs when your immune system attacks healthy skin tissue. People who have this condition can go on to develop other SLE symptoms. It can be an early warning sign of the systemic disease, and patients with SLE often have skin symptoms. It’s not clear if it’s just a part of developing SLE or is a disease in its own right. One thing is clear: Unlike SLE, which mainly affects women, CLE is far more common in men.

There are three subtypes of cutaneous lupus – acute, subacute and chronic. All can cause rashes that range from mild and localized to more widespread and severe. Some go away without a trace; others leave significant scars. Here’s a closer look:  

1. Acute cutaneous lupus. The most recognizable sign of this type – is a painless malar (butterfly) rash that stretches across the nose and cheeks. Mild cases look like a blush; severe rashes are red and itchy. According to Henry Lee, MD, a dermatologist at New York Presbyterian Hospital and assistant professor at Weill Cornell Medical College in New York City, half of SLE patients will develop a malar rash, usually after sun exposure and often years before other symptoms.
2. Subacute cutaneous lupus erythematosus (SCLE). This can cause two kinds of lesions: red, ring-shaped sores that sometimes overlap like interlocking circles, and a raised rash that resembles psoriasis. Some people have both. SCLE can occur anywhere on your body except your face, and like other types of cutaneous lupus, is often triggered by sunlight. Certain prescription drugs can also cause SCLE, especially some heart medications, proton pump inhibitors, anti-fungals, chemotherapy medications and tumor necrosis factor blockers. In one of the largest case studies of cutaneous lupus to date, 20% of patients were found to have symptoms caused by medications.  A certain percentage of people with SCLE also develop SLE or other autoimmune diseases like Sjogren’s syndrome. Doctors should consider both medications and other autoimmune diseases in patients with SCLE. 
3. Chronic Cutaneous Lupus. This form of cutaneous lupus has different subtypes, but the most common is discoid lupus erythematosus (DLE) – named for the coin-shaped sores that mainly appear on the face, ears and scalp. These can cause permanent scarring, changes in pigmentation and sometimes irreversible hair loss. Early diagnosis and treatment are important.

There is no cure for cutaneous lupus, so the goal is to improve the way your skin looks, prevent scarring and help you feel better overall. Doctors agree that non-drug treatments are the first line of defense. These include:

• Avoiding drugs that can trigger symptoms; 
• Not smoking; 
• Protecting yourself from the ultraviolet light, by wearing a broad spectrum, SPF 30 sunscreen and protective clothing (long sleeves, long pants and a broad-brimmed hat) whenever you’re outdoors or in a car – and even under fluorescent lights.

The type of drugs prescribed largely depends on the kind of cutaneous lupus you have and how severe or widespread it is. These are some drug-based treatments doctors may try: 

• Steroid ointments are often the first choice for mild-to-moderate symptoms and relatively small areas. But steroids can cause other problems, including thin or slow-to-heal skin and cataracts if used near your eyes for long periods.
• Topical calcineurin inhibitor like tacrolimus (Protopic, Prograf) or pimecrolimus (Elidel) may be prescribed to avoid steroid side effects. These creams are effective for skin lesions, but the pills have been linked to certain cancers. And, because they’re relatively new, their long-term safety isn’t known.
• First-line systemic treatments include anti-malarial drugs, with hydroxychloroquine the preferred choice. Studies suggest it works for about 60% of people with cutaneous lupus, but may be less effective in those who have SLE.
• Low-dose methotrexate or an anti-inflammatory drug such as dapsone (Aczone) may be tried if anti-malarials don’t work. Both have their own side effects, some of them serious. Be sure you understand all the potential side effects of any medications you take.