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Subacute Cutaneous Lupus Erythematosus (SCLE) Treatment & Management

  • Author: Janice Lin, MD, MPH; Chief Editor: William D James, MD  more...
Updated: Mar 07, 2016

Approach Considerations

The goals of management in subacute cutaneous lupus erythematosus (SCLE) are to improve the patient's appearance, mitigate any associated symptoms, prevent the development of additional lesions, and assess for potential associated systemic disease.[25] Counsel patients regarding the risk of serious systemic disease. Although many patients fulfill the criteria for systemic lupus erythematosus (SLE), the severity of systemic manifestations tends to be more mild, and renal and central nervous system (CNS) disease occur less frequently than in patients with SLE without associated SCLE.

Surgical approaches rarely are needed in patients with SCLE. Cosmetic measures are often less important in patients with this condition than in patients with discoid lupus erythematosus (DLE), given the lack of associated scarring; however, active disease and postinflammatory dyspigmentation may still cause notable cosmetic concerns in patients with SCLE. No special diet is required with SCLE.

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.


Skin Protection

Therapy begins with sun-protective measures, including sunscreens, protective clothing, and behavior alteration. A sunscreen containing Mexoryl SX and Mexoryl XL, tested in a randomized, placebo-controlled trial, was demonstrated to prevent the development of UV-induced cutaneous lesions.[26, 27]

Another study demonstrated that in an experimental setting, cutaneous lupus erythematosus (CLE) can be prevented by the use of a particular broad-spectrum sunscreen. The use of sunscreens in a clinical setting is not as effective as would be predicted from studies such as this one, perhaps because patients do not perform sunscreen application on a daily basis in a manner that might be effective.[28]

Broad-spectrum sunscreen with a sun protection factor (SPF) of 30 or greater should be applied at least 20 minutes prior to sun exposure and be reapplied every 2-3 hours. Often, sun avoidance and protective clothing are necessary in patients with subcutaneous lupus erythematosus (SCLE). Of note, skin disease in SCLE is often very challenging to control without adequate photoprotection.


Pharmacologic Therapy

Standard therapy includes topical and/or intralesional corticosteroids and antimalarials such as hydroxychloroquine or chloroquine. In patients with skin lesions refractory to hydroxychloroquine monotherapy, adding quinacrine can improve response.[29] A French multicenter study found that the measurement of hydroxychloroquine blood levels may correlate with the incidence of remission in patients with cutaneous lupus erythematosus. The most practical portion of this study is the potential use of blood levels to demonstrate a lack of compliance with therapy as those patients with very low levels had little clinical response.[30]

Additional therapies that may be considered in selected patients include thalidomide, methotrexate, mycophenolate mofetil, azathioprine, retinoids, dapsone, intravenous immunoglobulin, cyclosporine, auranofin, clofazimine, interferon, immunosuppressive agents such as cyclophosphamide and rituximab, and the monoclonal antibody belimumab.[31, 32, 33, 34, 35]

Lenalidomide, a thalidomide analogue, can be helpful in treating patients with refractory cutaneous lupus erythematosus (CLE) as well. Studies have shown skin improvement measured by CLASI (Cutaneous Lupus Erythematosus Disease Area and Severity Index) scores as early as 2 weeks after treatment initiation, although clinical relapse was common following medication withdrawal.[36]

Avoid systemic corticosteroids except for acute short-term usage or when the presence of systemic disease warrants use. Patients who smoke appear to respond less well to antimalarial therapy. Note that clofazimine is primarily beneficial for cutaneous, not systemic, disease.

Some patients with CLE have been found to be vitamin D deficient, particularly those who use careful photoprotection; therefore, the use of vitamin D and calcium should be considered following an assessment of vitamin D levels.[37]

Several upcoming therapeutic targets focus on type I interferons and receptors, anti-B-cell strategies, the toll-like receptor signaling pathway, and the JAK-STAT signaling pathway and may lead to additional treatment options for patients with cutaneous lupus in the future.[38]



Consultations with the following specialists may be helpful:

  • Rheumatologist - When joints and/or systemic involvement are involved
  • Nephrologist - When renal involvement is present
  • Neurologist - When CNS disease is present
  • Ophthalmologist – Patients treated with antimalarials need periodic ocular evaluations

Long-Term Monitoring

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 complete blood count (CBC), renal function tests, and urinalysis. Repeat autoantibody testing is of little use in patients with SCLE, unless they have systemic lupus erythematosus (SLE). Regularly assess historical information concerning additional systemic manifestations.

Contributor Information and Disclosures

Janice Lin, MD, MPH Clinical Instructor, Department of Immunology and Rheumatology, Stanford University School of Medicine

Janice Lin, MD, MPH is a member of the following medical societies: American College of Physicians, American College of Rheumatology, Medical Dermatology Society, Rheumatologic Dermatology Society

Disclosure: Nothing to disclose.


Jeffrey P Callen, MD Professor of Medicine (Dermatology), 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, American College of Rheumatology

Disclosure: Received income in an amount equal to or greater than $250 from: XOMA; Biogen/IDEC; Novartis; Janssen Biotech, Abbvie, CSL pharma<br/>Received honoraria from UpToDate for author/editor; Received honoraria from JAMA Dermatology for associate editor and intermittent author; Received royalty from Elsevier for book author/editor; Received dividends from trust accounts, but I do not control these accounts, and have directed our managers to divest pharmaceutical stocks as is fiscally prudent from Stock holdings in various trust accounts include some pharmaceutical companies and device makers for i inherited these trust accounts; for: Celgene; Pfizer; 3M; Johnson and Johnson; Merck; Abbott Laboratories; AbbVie; Procter and Gamble; Amgen.

Ruth Ann Vleugels, MD, MPH Assistant Professor of Dermatology, Harvard Medical School; Associate Physician, Department of Dermatology, Brigham and Women's Hospital; Associate Physician, Department of Immunology and Allergy, Children's Hospital Boston

Ruth Ann Vleugels, MD, MPH is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American College of Rheumatology, American Medical Association, Society for Investigative Dermatology, Medical Dermatology Society, Dermatology Foundation

Disclosure: Nothing to disclose.

Specialty Editor Board

Michael J Wells, MD, FAAD Associate Professor, Department of Dermatology, Texas Tech University Health Sciences Center, Paul L Foster School of Medicine

Michael J Wells, MD, FAAD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, Texas Medical Association

Disclosure: Nothing to disclose.

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, Texas Medical Association

Disclosure: Nothing to disclose.

Chief Editor

William D James, MD Paul R Gross Professor of Dermatology, Vice-Chairman, Residency Program Director, Department of Dermatology, University of Pennsylvania School of Medicine

William D James, MD is a member of the following medical societies: American Academy of Dermatology, Society for Investigative Dermatology

Disclosure: Nothing to disclose.

  1. Biazar C, Sigges J, Patsinakidis N, Ruland V, Amler S, Bonsmann G, et al. Cutaneous lupus erythematosus: first multicenter database analysis of 1002 patients from the European Society of Cutaneous Lupus Erythematosus (EUSCLE). Autoimmun Rev. 2013 Jan. 12(3):444-54. [Medline].

  2. Lin JH, Dutz JP, Sontheimer RD, Werth VP. Pathophysiology of cutaneous lupus erythematosus. Clin Rev Allergy Immunol. 2007 Oct. 33(1-2):85-106. [Medline].

  3. Braunstein I, Klein R, Okawa J, Werth VP. The interferon-regulated gene signature is elevated in subacute cutaneous lupus erythematosus and discoid lupus erythematosus and correlates with the cutaneous lupus area and severity index score. Br J Dermatol. 2012 May. 166(5):971-5. [Medline]. [Full Text].

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

  5. Grönhagen CM, Fored CM, Linder M, Granath F, Nyberg F. Subacute cutaneous lupus erythematosus and its association with drugs: a population-based matched case-control study of 234 patients in Sweden. Br J Dermatol. 2012 Aug. 167(2):296-305. [Medline].

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

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

  8. 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. 2005 Oct. 52(10):3073-8. [Medline].

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

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

  11. Wiznia LE, Subtil A, Choi JN. Subacute cutaneous lupus erythematosus induced by chemotherapy: gemcitabine as a causative agent. JAMA Dermatol. 2013 Sep. 149(9):1071-5. [Medline].

  12. Grönhagen CM, Fored CM, Linder M, Granath F, Nyberg F. Subacute cutaneous lupus erythematosus and its association with drugs: a population-based matched case-control study of 234 patients in Sweden. Br J Dermatol. 2012 Aug. 167(2):296-305. [Medline].

  13. Brunasso A, Aberer W, Massone C. Subacute lupus erythematosus during treatment with golimumab for seronegative rheumatoid arthritis. Lupus. 2014. 23(2):201-3. [Medline].

  14. Wilkerson E, Hazey MA, Bahrami S, Callen JP. Golimumab-exacerbated subacute cutaneous lupus erythematosus. Arch Dermatol. 2012 Oct. 148(10):1186-90. [Medline].

  15. Lowe G, Henderson CL, Grau RH, Hansen CB, Sontheimer RD. A systematic review of drug-induced subacute cutaneous lupus erythematosus. Br J Dermatol. 2011 Mar. 164(3):465-72. [Medline].

  16. Durosaro O, Davis MD, Reed KB, Rohlinger AL. Incidence of cutaneous lupus erythematosus, 1965-2005: a population-based study. Arch Dermatol. 2009 Mar. 145 (3):249-53. [Medline].

  17. Durosaro O, Davis MD, Reed KB, Rohlinger AL. Incidence of cutaneous lupus erythematosus, 1965-2005: a population-based study. Arch Dermatol. 2009 Mar. 145(3):249-53. [Medline].

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

  19. Sontheimer RD. Subacute cutaneous lupus erythematosus. Clin Dermatol. 1985 Jul-Sep. 3 (3):58-68. [Medline].

  20. Callen JP, Kulick KB, Stelzer G, Fowler JF. Subacute cutaneous lupus erythematosus. Clinical, serologic, and immunogenetic studies of forty-nine patients seen in a nonreferral setting. J Am Acad Dermatol. 1986 Dec. 15(6):1227-37. [Medline].

  21. Tiao J, Feng R, Carr K, Okawa J, Werth VP. Using the American College of Rheumatology (ACR) and Systemic Lupus International Collaborating Clinics (SLICC) criteria to determine the diagnosis of systemic lupus erythematosus (SLE) in patients with subacute cutaneous lupus erythematosus (SCLE). J Am Acad Dermatol. 2016 Feb 18. [Medline].

  22. Tebbe B, Mansmann U, Wollina U, Auer-Grumbach P, Licht-Mbalyohere A, Arensmeier M, et al. Markers in cutaneous lupus erythematosus indicating systemic involvement. A multicenter study on 296 patients. Acta Derm Venereol. 1997 Jul. 77 (4):305-8. [Medline].

  23. David-Bajar KM, Bennion SD, DeSpain JD, Golitz LE, Lee LA. Clinical, histologic, and immunofluorescent distinctions between subacute cutaneous lupus erythematosus and discoid lupus erythematosus. J Invest Dermatol. 1992 Sep. 99 (3):251-7. [Medline].

  24. Rothfield N, Sontheimer RD, Bernstein M. Lupus erythematosus: systemic and cutaneous manifestations. Clin Dermatol. 2006 Sep-Oct. 24 (5):348-62. [Medline].

  25. Hejazi EZ, Werth VP. Cutaneous Lupus Erythematosus: An Update on Pathogenesis, Diagnosis and Treatment. Am J Clin Dermatol. 2016 Feb 12. [Medline].

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

  27. 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. 2002 Jul-Aug. 12(4):VII-IX. [Medline].

  28. Kuhn A, Gensch K, Haust M, Meuth AM, Boyer F, Dupuy P, et al. Photoprotective effects of a broad-spectrum sunscreen in ultraviolet-induced cutaneous lupus erythematosus: a randomized, vehicle-controlled, double-blind study. J Am Acad Dermatol. 2011 Jan. 64(1):37-48. [Medline].

  29. Chang AY, Piette EW, Foering KP, Tenhave TR, Okawa J, Werth VP. Response to antimalarial agents in cutaneous lupus erythematosus: a prospective analysis. Arch Dermatol. 2011 Nov. 147(11):1261-7. [Medline]. [Full Text].

  30. Francès C, Cosnes A, Duhaut P, Zahr N, Soutou B, Ingen-Housz-Oro S, et al. Low blood concentration of hydroxychloroquine in patients with refractory cutaneous lupus erythematosus: a French multicenter prospective study. Arch Dermatol. 2012 Apr. 148(4):479-84. [Medline].

  31. Hofmann SC, Leandro MJ, Morris SD, Isenberg DA. Effects of rituximab-based B-cell depletion therapy on skin manifestations of lupus erythematosus--report of 17 cases and review of the literature. Lupus. 2013 Aug. 22(9):932-9. [Medline].

  32. 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. 2003 Jan. 139(1):50-4. [Medline].

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

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

  35. Manzi S, Sánchez-Guerrero J, Merrill JT, Furie R, Gladman D, Navarra SV, et al. Effects of belimumab, a B lymphocyte stimulator-specific inhibitor, on disease activity across multiple organ domains in patients with systemic lupus erythematosus: combined results from two phase III trials. Ann Rheum Dis. 2012 Nov. 71 (11):1833-8. [Medline].

  36. Cortés-Hernández J, Avila G, Vilardell-Tarrés M, Ordi-Ros J. Efficacy and safety of lenalidomide for refractory cutaneous lupus erythematosus. Arthritis Res Ther. 2012 Dec 7. 14(6):R265. [Medline]. [Full Text].

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

  38. Klaeschen AS, Wenzel J. Upcoming Therapeutic Targets in Cutaneous Lupus Erythematous. Expert Rev Clin Pharmacol. 2016 Jan 22. [Medline].

  39. James JA, Kim-Howard XR, Bruner BF, Jonsson MK, McClain MT, Arbuckle MR, et al. Hydroxychloroquine sulfate treatment is associated with later onset of systemic lupus erythematosus. Lupus. 2007. 16(6):401-9. [Medline].

  40. Jung H, Bobba R, Su J, Shariati-Sarabi Z, Gladman DD, Urowitz M, et al. The protective effect of antimalarial drugs on thrombovascular events in systemic lupus erythematosus. Arthritis Rheum. 2010 Mar. 62(3):863-8. [Medline].

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

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

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

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

  45. 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].

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

  47. 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. 2007 Jun. 156(6):1321-7. [Medline].

Early lesions of subacute cutaneous lupus erythematosus may simulate polymorphous light eruption.
Papulosquamous lesions of subacute cutaneous lupus erythematosus may simulate psoriasis.
Annular lesions of subacute cutaneous lupus erythematosus.
Tumid lupus erythematosus.
Neonatal lupus erythematosus.
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