LUPUS: A Guide for Nurses
Cutaneous lupus erythematosus includes a wide variety of skin problems, which have an equally diverse range of therapies. Each major form of Cutaneous LE may occur in isolation or as part of systemic lupus itself and skin problems occur in 98% of patients with SLE at some stage.
"Sub-acute cutaneous LE" (SCLE) usually takes the form of red, scaly, round lesions over the face, neck and chest which are induced by sunlight and, like the butterfly rash, heal without scarring. SCLE is particularly associated with a specific blood autoantibody, the so called 'Ro', which may be involved in causing the rash.
Chronic cutaneous lupus includes "Discoid lupus" (DLE) consisting of well-defined disc-like plaques on the skin or scalp which are long-lasting and which can lead to scarring and cosmetic problems.
Patients with lupus may suffer other skin problems which are not specific to lupus, such as vasculitis rashes, hair thinning, blisters, leg ulcers and prickly heat. Because of this diversity, a skin biopsy is sometimes required to help make an accurate diagnosis.
With regard to treatment of the specific lupus skin problems (butterfly rash, SCLE and DLE), education about sun-avoidance and sunscreens is the single most important factor. Topical treatments with steroid preparations such as eumovate and dermovate are also useful, but should only be used for short courses. The next step up includes systemic treatment with anti-malarials (e.g. hydroxychloroquine) and more potent drugs such as prednisolone, azathioprine and thalidomide.
Despite this range of therapies, some patients are left with long-term cosmetic problems, requiring expert advice in camouflage, for example from the Red Cross.