Treating Cutaneous Lupus and What to Look For

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What Is Cutaneous Lupus?

Cutaneous lupus (CL), an autoimmune disease, is one of four distinct types of lupus: systemic lupus erythematosus, neonatal lupus, drug-induced erythematosus, and cutaneous (skin) lupus erythematosus. According to the American Skin Association, women between the ages of 20 and 50 are most often affected.

The characteristic lupus rash, known as the butterfly rash because of its shape, is often first noticed following exposure to the sun. Many types of rashes, such as red scaly patches, lesions, and flat red patches, are associated with the disease. Signs of chronic CL, or discoid lupus, are round, disk-shaped lesions that usually appear on the face and scalp. Subacute cutaneous lesions may present as distinctly outlined red scaly skin, and acute CL symptoms include the malar rash recognized as the “butterfly rash.”

Corticosteroids

Corticosteroids are prescribed as topical creams, gels, ointments and sprays for direct application to the skin; tablets, syrups and capsules to be taken by mouth; and injectables to be given as shots. Steroids reduce inflammation and immune system activity.

There are varying strengths of topical corticosteroids used to treat skin diseases. The American Academy of Family Physicians lists high-potency steroids as possible treatment for discoid lupus erythematosus (DLE), a chronic form of cutaneous lupus. Topical corticosteroids take longer for absorption into the blood stream; therefore, the systemic impact is less than other methods of administration. Side effects, such as skin atrophy, may occur, especially if you have thin skin and use high-potency steroids. Risks for adverse skin response increase with the elderly.

Corticosteroids taken by mouth provide a system-wide coverage that also carries a higher risk of significant side effects, according to the Mayo Clinic. Mood swings, fluid retention, elevated eye pressure and blood pressure, weight gain, menstrual irregularities and calcium loss are some of the possible side effects.

Injectable corticosteroids may be necessary for treating cutaneous lupus, if systemic lupus erythematosus is involved and joints are affected. Side effects may include irritation at the point of injection.

Antimalarials

Antimalarials, such as hydroxychloroquine, chloroquine and quinacrine, are effective in treating DLE with 60 to 90 percent showing major improvements or remission following antimalarial treatment, according to the Lupus Foundation of America, Inc. Possible side effects of antimalarials include dry skin, poor appetite, stomach upset and cramps, bloating, headaches, weakness and muscle aches. The risk of retinal damage is increased with the higher doses of Plaquenil, a hydroxychloroquine product or Aralen, a chloroquine product. While retinal damage related to Plaquenil may be reversible, damage from Aralen is irreversible.

Other Medications

The Lupus Foundation of America reports thalidomide, a drug used in the treatment of leprosy, is recognized as effective for treating cutaneous lupus. Significant improvement is noted in 75 to 90 percent of people treated with thalidomide. Significant side effects noted with thalidomide use include severe birth defects, neuropathy and drowsiness.

Acute cutaneous lupus may require immunosuppressive drugs, such as methotrexate and azathioprine for adequate control. Severe side effects of both include liver toxicity and low white blood cell count. Neither drug is safe for use during pregnancy or while nursing.

References

American Skin Association: Cutaneous Lupus Erythematosus https://www.americanskin.org/resource/lupus.php

American Academy of Family Physicians: Choosing Topical Corticosteroids https://www.aafp.org/afp/2009/0115/p135.html

Mayo Clinic: Prednisone and Other Corticosteroids: Balance the Risks and Benefits https://www.mayoclinic.com/health/steroids/HQ01431

Lupus Foundation of America, Inc.: Anti-Malarials https://www.lupus.org/webmodules/webarticlesnet/templates/default.aspx?a=87&template=print-article.htm