Internal Medicine

0521779407-C04 CUNY1086/Karliner 0 521 77940 7 June 14, 2007 20:37

Cutaneous Lupus Erythematosus (LE) 443

management

What to Do First

1. All – evaluate carefully for evidence of underlying systemic LE (SLE)
   activity. If found, treat appropriately with systemic immunomodu-
   latory therapy (corticosteroids, antimalarials).


2. SCLE – assess for the possibility of drug induction (as discussed
   above) as a cause and discontinue in applicable situations.

General Measures

■All – counsel patient about the relationships between cutaneous and

systemic manifestations of LE to allay fears and encourage compli-

ance (ACLE – greatest risk, localized DLE – lowest risk, SCLE – low

to intermediate risk). Encourage use of sunscreens. Educate about

ultraviolet light avoidance techniques.

specific therapy

Indications

■Presence of symptomatic skin disease

Treatment Options

■All – topical corticosteroid creams, ointments, gels, foams, and solu-

tions with careful attention to location, strength and duration of

treatment to prevent atrophogenic side effects in skin. Intralesional

injections of triamcinolone acetonide may be useful as an adjunctive

therapy.

■Hydroxychloroquine without or with or other antimalarial agent

(quinacrine) for non- or partial responders

■Alternative systemic therapy: dapsone, retinoids, thalidomide,

immunosuppressives, particularly methotrexate, azathioprine or

mycophenolate mofetil

follow-up

During Treatment

■All – watch for treatment side effects and development or exac-

erbation of intercurrent SLE activity. Ophthalmologic examination

at baseline and bi-annual while on hydroxychloroquine or chloro-

quine. Cigarette smoking in some individuals blunts the clinical

response of cutaneous LE to antimalarial.

Routine

■All – actively treat skin disease activity when flaring. Cautious with-

drawal of therapy when skin disease activity remits (some patients