eMedicine Specialties > Dermatology > Connective Tissue Diseases

Lupus Erythematosus, Subacute Cutaneous: Follow-up

Author: Jeffrey P Callen, MD, Professor of Medicine, Chief, Division of Dermatology, University of Louisville School of Medicine
Contributor Information and Disclosures

Updated: Apr 13, 2009

Follow-up

Further Inpatient Care

  • Inpatient care is rarely needed for patients with skin disease; however, since these patients may have SLE, they may occasionally manifest internal complications that require hospitalization. In these instances, consultation with other physicians may be helpful.

Further Outpatient Care

  • Follow patients with subacute cutaneous lupus erythematosus (SCLE) at regular intervals.
  • Response to therapy varies, depending on the therapeutic agent prescribed. Avoid changes in therapy until a sufficient period elapses to note a response.
  • At least once each year, and perhaps twice, assess stable patients using routine laboratory tests, including CBC count, renal function tests, and urinalysis. Repeat autoantibody testing is of little use in patients with SCLE, unless they have SLE. In patients with SLE, serial anti-nDNA antibody testing may predict the course of the disease.
  • Regularly assess historical information concerning additional systemic manifestations.

Complications

  • SCLE usually leaves no residual changes on the skin. Occasionally, dyspigmentation may be seen.
  • Severe systemic disease is unusual, but when it occurs, the patient may develop life-altering sequelae.

Prognosis

  • SCLE uncomplicated by severe SLE has a good prognosis. Some patients may manifest spontaneous remission; however, most have chronically active disease or a course punctuated by intermittent exacerbations.
  • Exacerbation in the spring or summer is not uncommon.

Patient Education

Miscellaneous

Medicolegal Pitfalls

  • Failure to diagnose the disease
  • Failure to appreciate serious systemic involvement
  • Failure to recognize toxic effects of therapy
 


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References
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References

  1. Klein LR, Elmets CA, Callen JP. Photoexacerbation of cutaneous lupus erythematosus due to ultraviolet A emissions from a photocopier. Arthritis Rheum. Aug 1995;38(8):1152-6. [Medline].

  2. Reed BR, Huff JC, Jones SK, Orton PW, Lee LA, Norris DA. Subacute cutaneous lupus erythematosus associated with hydrochlorothiazide therapy. Ann Intern Med. Jul 1985;103(1):49-51. [Medline].

  3. Bentley DD, Graves JE, Smith DI, Heffernan MP. Efalizumab-induced subacute cutaneous lupus erythematosus. J Am Acad Dermatol. May 2006;54(5 Suppl):S242-3. [Medline].

  4. Bezerra EL, Vilar MJ, da Trindade Neto PB, Sato EI. Double-blind, randomized, controlled clinical trial of clofazimine compared with chloroquine in patients with systemic lupus erythematosus. Arthritis Rheum. Oct 2005;52(10):3073-8. [Medline].

  5. Cassis TB, Callen JP. Bupropion-induced subacute cutaneous lupus erythematosus. Australas J Dermatol. Nov 2005;46(4):266-9. [Medline].

  6. Farhi D, Viguier M, Cosnes A, Reygagne P, et al. Terbinafine-induced subacute cutaneous lupus erythematosus. Dermatology. 2006;212(1):59-65. [Medline].

  7. Sontheimer RD, Henderson CL, Grau RH. Drug-induced subacute cutaneous lupus erythematosus: a paradigm for bedside-to-bench patient-oriented translational clinical investigation. Arch Dermatol Res. Jan 2009;301(1):65-70. [Medline].

  8. Cohen MR, Crosby D. Systemic disease in subacute cutaneous lupus erythematosus: a controlled comparison with systemic lupus erythematosus. J Rheumatol. Sep 1994;21(9):1665-9. [Medline].

  9. Black DR, Hornung CA, Schneider PD, Callen JP. Frequency and severity of systemic disease in patients with subacute cutaneous lupus erythematosus. Arch Dermatol. Sep 2002;138(9):1175-8. [Medline].

  10. Herzinger T, Plewig G, Rocken M. Use of sunscreens to protect against ultraviolet-induced lupus erythematosus. Arthritis Rheum. Sep 2004;50(9):3045-6. [Medline].

  11. Stege H, Budde MA, Grether-Beck S, Richard A, Rougier A, Krutmann J. Evaluation of the capacity of sunscreens to photoprotect lupus erythematosus patients by employing the photoprovocation test. Eur J Dermatol. Jul-Aug 2002;12(4):VII-IX. [Medline].

  12. Cusack C, Danby C, Fallon JC, et al. Photoprotective behaviour and sunscreen use: impact on vitamin D levels in cutaneous lupus erythematosus. Photodermatol Photoimmunol Photomed. Oct 2008;24(5):260-7. [Medline].

  13. Clayton TH, Ogden S, Goodfield MD. Treatment of refractory subacute cutaneous lupus erythematosus with efalizumab. J Am Acad Dermatol. May 2006;54(5):892-5. [Medline].

  14. Housman TS, Jorizzo JL, McCarty MA, Grummer SE, Fleischer AB Jr, Sutej PG. Low-dose thalidomide therapy for refractory cutaneous lesions of lupus erythematosus. Arch Dermatol. Jan 2003;139(1):50-4. [Medline].

  15. Sticherling M, Bonsmann G, Kuhn A. Diagnostic approach and treatment of cutaneous lupus erythematosus. J Dtsch Dermatol Ges. Jan 2008;6(1):48-59. [Medline].

  16. Usmani N, Goodfield M. Efalizumab in the treatment of discoid lupus erythematosus. Arch Dermatol. Jul 2007;143(7):873-7. [Medline].

  17. Callen JP, Klein J. Subacute cutaneous lupus erythematosus. Clinical, serologic, immunogenetic, and therapeutic considerations in seventy-two patients. Arthritis Rheum. Aug 1988;31(8):1007-13. [Medline].

  18. Callen JP. Management of "refractory" skin disease in patients with lupus erythematosus. Best Pract Res Clin Rheumatol. Oct 2005;19(5):767-84. [Medline].

  19. Callen JP. Cutaneous lupus erythematosus: a personal approach to management. Australas J Dermatol. Feb 2006;47(1):13-27. [Medline].

  20. Huber A, Tuting T, Bauer R, Bieber T, Wenzel J. Methotrexate treatment in cutaneous lupus erythematosus: subcutaneous application is as effective as intravenous administration. Br J Dermatol. Oct 2006;155(4):861-2. [Medline].

  21. Kreuter A, Hyun J, Altmeyer P, Gambichler T. Intravenous immunoglobulin for recalcitrant subacute cutaneous lupus erythematosus. Acta Derm Venereol. 2005;85(6):545-7. [Medline].

  22. Wenzel J, Brahler S, Bauer R, Bieber T, Tuting T. Efficacy and safety of methotrexate in recalcitrant cutaneous lupus erythematosus: results of a retrospective study in 43 patients. Br J Dermatol. Jul 2005;153(1):157-62. [Medline].

  23. Kreuter A, Tomi NS, Weiner SM, Huger M, Altmeyer P, Gambichler T. Mycophenolate sodium for subacute cutaneous lupus erythematosus resistant to standard therapy. Br J Dermatol. Jun 2007;156(6):1321-7. [Medline].

  24. Kuhn A, Bijl M. Pathogenesis of cutaneous lupus erythematosus. Lupus. 2008;17(5):389-93. [Medline].

  25. Lee LA, David KM. Cutaneous lupus erythematosus. Curr Probl Dermatol. 1989;1:161-210.

  26. McCauliffe DP. Cutaneous diseases in adults associated with anti-Ro/SS-A autoantibody production. Lupus. 1997;6(2):158-66. [Medline].

  27. Sontheimer RD. The lexicon of cutaneous lupus erythematosus--a review and personal perspective on the nomenclature and classification of the cutaneous manifestations of lupus erythematosus. Lupus. 1997;6(2):84-95. [Medline].

  28. Sontheimer RD, Thomas JR, Gilliam JN. Subacute cutaneous lupus erythematosus: a cutaneous marker for a distinct lupus erythematosus subset. Arch Dermatol. Dec 1979;115(12):1409-15. [Medline].

  29. Srivastava M, Rencic A, Diglio G, et al. Drug-induced, Ro/SSA-positive cutaneous lupus erythematosus. Arch Dermatol. Jan 2003;139(1):45-9. [Medline].

  30. Stavropoulos PG, Goules AV, Avgerinou G, Katsambas AD. Pathogenesis of subacute cutaneous lupus erythematosus. J Eur Acad Dermatol Venereol. Nov 2008;22(11):1281-9. [Medline].

  31. Wang D, Drenker M, Eiz-Vesper B, Werfel T, Wittmann M. Evidence for a pathogenetic role of interleukin-18 in cutaneous lupus erythematosus. Arthritis Rheum. Oct 2008;58(10):3205-15. [Medline].

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Further Reading

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Keywords

subacute cutaneous lupus erythematosus, SCLE, systemic lupus erythematosus, SLE, lupus, autoimmune disease, discoid lupus erythematosus, Sjogren syndrome

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Contributor Information and Disclosures

Author

Jeffrey P Callen, MD, Professor of Medicine, Chief, Division of Dermatology, University of Louisville School of Medicine
Jeffrey P Callen, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American College of Physicians, and American College of Rheumatology
Disclosure: Amgen Honoraria Consulting; Abbott Honoraria Consulting; Electrical Optical Sciences Honoraria Consulting; Centocor Honoraria Consulting; Genetech Honoraria Consulting; Celgene Honoraria Consulting

Medical Editor

Kathleen David-Bajar, MD, Former Consultant to the Army Surgeon General, Department of Dermatology, Brooke Army Medical Center
Kathleen David-Bajar, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Dermatology
Disclosure: Nothing to disclose.

Pharmacy Editor

Michael J Wells, MD, Associate Professor, Department of Dermatology, Texas Tech University Health Sciences Center
Michael J Wells, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, and Texas Medical Association
Disclosure: Nothing to disclose.

Managing Editor

Lester F Libow, MD, Dermatopathologist, South Texas Dermatopathology Laboratory
Lester F Libow, MD is a member of the following medical societies: American Academy of Dermatology, American Society of Dermatopathology, and Texas Medical Association
Disclosure: Nothing to disclose.

CME Editor

Joel M Gelfand, MD, MSCE, Medical Director, Clinical Studies Unit, Assistant Professor, Department of Dermatology, Associate Scholar, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania
Joel M Gelfand, MD, MSCE is a member of the following medical societies: Society for Investigative Dermatology
Disclosure: AMGEN Consulting fee Consulting; AMGEN Grant/research funds None; Genentech Consulting fee Consulting; Centocor Consulting fee Consulting; Centocor Grant/research funds None; Covance Consulting fee Consulting; Shire  Consulting

Chief Editor

William D James, MD, Paul R Gross Professor of Dermatology, University of Pennsylvania School of Medicine; Vice-Chair, Program Director, Department of Dermatology, University of Pennsylvania Health System
William D James, MD is a member of the following medical societies: American Academy of Dermatology and Society for Investigative Dermatology
Disclosure: elsevier Royalty Other; american college of physicians Honoraria Other

 
 
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