Subacute Cutaneous Lupus Erythematosus (SCLE) Treatment & Management

  • Author: Jeffrey P Callen, MD; Chief Editor: William D James, MD   more...
 
Updated: Aug 23, 2011
 

Approach Considerations

The goals of management in subacute cutaneous lupus erythematosus (SCLE) are to improve the patient's appearance and to prevent the development of additional lesions. Counsel patients regarding the risk of serious systemic disease. Traditionally, it was suggested that although many patients fulfilled the criteria for SLE, the severity of systemic manifestations was mild, and renal and central nervous system (CNS) disease rarely occurred.

Cohen and Crosby found no appreciable difference between SCLE and SLE patients seen in a rheumatology practice,[10] whereas Black et al found significant differences between these 2 populations.[11] Inform patients that although they probably will not have serious systemic disease, follow-up evaluation and treatment will be performed for manifestations that may occur.

Surgical approaches rarely are needed in patients with SCLE. Also, cosmetic measures are less important in patients with this condition than in patients with DLE. 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.

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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.[12, 13]

Another study demonstrated that in an experimental setting, 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.[14]

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Pharmacologic Therapy

Standard therapy includes corticosteroids (topical, intralesional) and antimalarials. Additional therapies that may be considered in selected patients include auranofin, dapsone, thalidomide, retinoids, interferon, and immunosuppressive agents.[15, 16, 17]

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 cutaneous LE have been found to be vitamin D deficient; therefore, the use of vitamin D and calcium should be considered following an assessment of vitamin D levels.[18]

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Consultations

Consultations with the following specialists may be helpful:

  • Rheumatologist - When joints are involved
  • Nephrologist - When renal involvement is present
  • Neurologist - When CNS disease is present
  • Internal medicine specialist - For systemic involvement
  • Ophthalmologist – Many patients will be treated with antimalarials and such patients need periodic ocular evaluations
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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 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.

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Contributor Information and Disclosures
Author

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, and American College of Rheumatology

Disclosure: Amgen Honoraria Consulting; Abbott Honoraria Consulting; Electrical Optical Sciences Consulting fee Consulting; Celgene Honoraria Safety Monitoring Committee; GSK - Glaxo Smith Kline Consulting fee Consulting; TenXBioPharma Consulting fee Safety Monitoring Committee

Specialty Editor Board

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

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.

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.

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

References

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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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