...less medical jargon in a 'Quick Glance' format!
Subacute Cutaneous Lupus or subacute cutaneous lupus erythematosus (SCLE) is a nonscarring non–atrophy-producing photosensitive dermatosis. SCLE may occur in patients with systemic lupus erythematosus (SLE), Sjögren syndrome, or it may be drug induced.
This lesion is characterized as a non-scarring, red coin-shaped lesion which is very photosensitive, meaning it gets worse when exposed to UV light.
Unlike the discoid lupus lesions, these lesions do not produce permanent scarring, but can be of major cosmetic significance
SCLE causes red, elevated areas of skin with distinct margins. Annular lesions are red and ring shaped. Both kinds are typically dry, and do not itch. These rashes most commonly appear on sun exposed areas, most commonly the the neck, chest, upper back, arms and face. Other areas can be affected as well. Fatigue is common. Arthralgia or arthritis may also occur. Some patients also have Systemic Lupus Erythematosus (SLE). Patients without SLE may still manifest SLE symptoms with SCLE.
While the exact cause is not known, patients with subacute cutaneous lupus probably have a genetic predisposition. The disease usually becomes active after UV light exposure but scientists believe there must be other triggering factors. Certain drugs especially hydrochlorothiazide, calcium channel blockers, angiotensin-converting enzyme inhibitors, terbinafine, and tumor necrosis factor antagonists may induce SCLE.
. . . Medical Care
The goals of management are to improve the patient's appearance and to prevent the development of further lesions.
Counsel patients regarding the risk of serious systemic disease. The frequency and severity of systemic disease in patients with SCLE is controversial. Traditionally, it was suggested that although many patients fulfilled the criteria for SLE, the severity of systemic manifestations was mild, and renal and CNS disease rarely occurred. Cohen and Crosby found no appreciable difference between SCLE and SLE patients seen in a rheumatology practice, whereas Black et al found significant differences between these 2 populations. 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.
Therapy begins with sun-protective measures, including sunscreens, protective clothing, and behavior alteration. One sunscreen has been tested in a randomized placebo-controlled trial and was demonstrated to prevent the development of UV-induced cutaneous lesions among patients who used a sunscreen that contained Mexoryl SX and Mexoryl XL.
Cosmetic measures are less important in patients with SCLE than in patients with DLE.
Standard therapy includes corticosteroids and antimalarials. Additional therapies that may be considered in selected patients include auranofin, ,strong>dapsone, thalidomide, retinoids, interferon, and immunosuppressive agents. 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.
. . . Surgical Care
Surgical approaches rarely are needed in SCLE patients.