Update on the Management of Cutaneous Lupus Erythematosus

J.P. Callen


The British Journal of Dermatology. 2004;151(4) 

In This Article


This paper reviews the latest treatments for cutaneous lupus erythematosus. It focuses on evidence-based guidance for the management of cutaneous lupus erythematosus, with identification of the strength of evidence available at this time. In addition, I have briefly reviewed the epidemiological aspects, diagnosis and evaluation of patients with cutaneous lupus erythematosus. This review reflects data available from the Cochrane Library, Medline, literature searches, and the experience of the author managing patients with cutaneous lupus erythematosus for over 25 years.

Cutaneous lupus erythematosus (LE) is an acquired autoimmune disorder that may manifest a variety of clinical presentations. Gilliam and Sontheimer were among the first to classify lesions based upon the presence or absence of the 'characteristic' histopathology, the interface dermatitis.[1] In this paper I will concentrate on the clinical syndromes associated with the interface dermatitis, including primarily chronic cutaneous LE and SCLE.

The prevalence of cutaneous lupus varies from 14·6 to 68 per 100 000 people.[2] The rate may be increasing or the recognition of LE may be increasing. Regardless, it appears that more cases are diagnosed now than in the past. Systemic LE is more common in women, and most cutaneous subsets of LE also are more prevalent in women, but the ratio is not as high. All races are affected.

The diagnosis of cutaneous LE is based upon the presence of compatible clinical lesions which on biopsy demonstrate a characteristic pathological picture. Immunofluorescence microscopy and serological testing are useful only as suggestive tests and must be considered only in appropriate circumstances. Serological findings are neither diagnostic nor exclusionary. Once a diagnosis of cutaneous LE has been established, the patient should be evaluated thoroughly to assess the presence of systemic disease associated with LE. In the absence of severe systemic disease, which is often the case, the focus of therapy may then be upon the skin.


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