Cutaneous lupus is seen in around 10% of the lupus cases and in this condition only the skin is affected. In this condition different types of skin lesions are seen among people. Lupus which is a condition affecting the immune system is marked by the appearance of a classic rash which is a red, scaly, raised rash shaped like a coin. Such a rash can be seen on a person’s face and in some cases it may occur in other regions of the body. When this rash heals scarring is seen to occur.
The different types of cutaneous lupus erythematosus include discoid lupus erythematosus, drug induced lupus erythematosus, lupus erythematosus tumidus, lupus profundus, subacute lupus erythematosus, neonatal lupus arythematosus, chilblain lupus erythematosus, cutaneous lupus mucinosis and systemic lupus erythematosus.
In cutaneous lupus excessive exposure to light particularly ultraviolet light results in this form of lupus. So people suffering from cutaneous lupus have to be particularly carefully and limit their exposure to sun. Such individuals also need to wear sunscreen and sun block agents. Some cases may further develop into systemic lupus erythematosus.
Cutaneous lupus can be seen in different clinical presentations but the treatment for this condition is quite similar even for the different forms. Scarring is the most prevalent problem with these patients and this problem must be treated with enough aggressiveness so as to prevent this from becoming a permanent issue. In the initial stages topical along with intralesional therapy may be given. However if the desired response is not attained then systemic therapy may be used.
Before treatment of cutaneous lupus is started it is important that the evaluation of the patients is done to determine and identify any signs of possible systemic disease. Such an initial evaluation is done by including a physical examination of the individual along with the history of the case. A CBC test, ANA, urinalysis and sedimentation rate tests should also be conducted.
The cornerstone of treatment of cutaneous lupus is avoiding sun exposure and using sunscreen agents. This is because these patients are extremely photosensitive. The most important purpose of treatment of cutaneous lupus erythematosus is improving the appearance of the patient and prevention of scarring. So if the lupus is drug induced then the medication responsible for it has to be identified and stopped. Nicotine is responsible for aggravating lupus so this should be stopped.
Cosmetic camouflage can be used so as to disguise plaques that are unsightly. Topical steroids in the form of ointments and creams may also be applied till the time the patches clear up. In some cases where the rashes are less severe a milder form of some topical steroid may be used. In some cases corticosteroid injections may also be used. Anti malarial tablets because of their anti inflammatory properties also help. In some cases oral steroids can also be prescribed. Some other options that may be used for severe cutaneous lupus include ciclosporin, methotrexate, acitretin, dapsone, ciclosporin, clofazamine and intravenous immunoglobulin.