Cutaneous lupus erythematoses

Abstract

The clinical features of the major types of cutaneous lupus arewell known. The three broad categories of discoid lupus, subcutaneous lupus and acute cutaneous lupus describe particular entities with generally discreet clinical features. However there is considerable overlap between these forms and the initial focus of management of patients presenting with cutaneous signs of lupus erythematosus consists of establishing the degree of systemic involvement present. In those patients with systemic disease the over-riding therapeutic need is for control of the systemic features of the condition. Cutaneous disease will normally respond at the same time. However there are many patients who have cutaneous disease as their major disease presentation. In these, choice of therapeutic option depends on the extent of cutaneous involvement, the time course of disease and the presence or absence of scarring. Whilst there is general agreement that first-line therapy with sunscreen, topical steroids and then if necessary anti-malarials is effective in the majority of patients (around two-thirds), subsequent therapy is based more on anecdote and experience than hard evidence. Being female, smoking and having extensive disease are features that often go together and lead to relative resistance to therapy. Once a single anti-malarial has failed in treatment, combination anti-malarials, dapsone, oral gold, methotrexate, thalidomide and many other agents have all been used though clinical evidence in support of their use is noticeable by its absence. Short courses of oral steroids are also often necessary in patients with severe and extensive disease as well as those with scarring. This talk will review the spectrum of disease, and the available treatment options.