Cutaneous Lupus Erythematosus

1. What is Lupus?
Lupus is a chronic (long-lasting) autoimmune disease where the immune system, for unknown reasons, becomes hyperactive and attacks normal tissue. This attack results in inammation and brings about symptoms.

2. What is Cutaneous Lupus Erythematosus (LE)?
Cutaneous LE aects the skin and the hair. It presents as skin rash, photosensitivity and occasionally mouth or nose ulcers.

3. How does it affect me?
It can cause permanent scarring and pigmentary changes of the skin and hair loss if not treated.

4. Is it the same as SLE (systemic lupus erythematosus)?
No, cutaneous LE is limited to the skin whereas systemic LE may involve any organ system in the body, as well as the skin. Organs affected in systemic LE include the joints, kidney, bone marrow and the central nervous system. There may also be prolonged or frequent fevers, mouth ulcers or hair loss. Your doctor will usually order certain blood tests in order to monitor your condition.

5. What is the treatment for Cutaneous Lupus Erythematosus?

Sun avoidance

• Do avoid excessive sun exposure as UV radiation can worsen the condition.
• Wear protective clothing, such as long sleeves and a hat.
• Apply sunscreen daily
• Use an umbrella if you are outdoors

Medicated creams

• Your doctor may prescribe topical steroid creams or other medicated creams for your skin condition. Please use them regularly as prescribed.
• Intralesional triamcinolone acetonide
  
• Occasionally, your doctor may recommend injecting a small volume of steroid solution directly into the lesions.
• This is most often performed for cutaneous LE on the scalp.
• Possible side eects of this procedure include skin thinning, skin discolouration (whitening) and folliculitis.

Oral medications

• These are prescribed when the condition is extensive or diffcult to control.
• Anti-malarial drugs (e.g., chloroquine and hydroxychloroquine)
• These are generally safe drugs with few side eects
• They may rarely cause blurring of vision due to toxicity in the eye
• You will be asked to undergo regular eye examination while you are taking this drug

Oral steroids (e.g., Prednisolone)

• These are prescribed in more severe cases of cutaneous LE.
• Possible side effects include:
  

1. Weight gain
2. Osteoporosis
3. Increased risk of hypertension, worsening of hypertension control
4. Increased risk of diabetes, worsening of diabetes control
5. Increased risk of gastritis and peptic ulcer disease
6. Change in mood
7. Skin thinning, stretch marks, easy bruising
8. Increased risk of infections or worsening of pre-existing infections
9. Muscle weakness
10. Joint pains, avascular necrosis of the hip
11. Cataract and glaucoma

Do inform your doctor if you have any new symptoms while on steroids. Your doctor will monitor your health and check your blood pressure and blood sugar levels regularly.