The mainstays of treatment of cutaneous lupus erythematosus (LE) are topical and intralesional steroids, sunscreen, and the antimalarials. However, the practitioner is often faced with the challenge of cutaneous disease unresponsive to these conventional measures. We present our approach to the management of cutaneous LE and review the literature regarding therapy of refractory disease.
Tan EM, Cohen AS, Fries JF et al. The 1982 revised criteria for the classification of systemic lupus erythematosus. Arthritis Rheum1982; 25: 1271-7.
2.
Estes D., Christian CLThe natural history of systemic lupus erythematosus studied by prospective analysis. Medicine (Baltimore)1971; 50: 85-95.
3.
Callen JPMucocutaneous changes in patients with lupus erythematosus: the relationship of these lesions to systemic disease. Rheum Dis Clin N Am1988; 14: 79-97.
4.
Callen JP, Fowler JF, Kulick KBSerological and clinical features of patients with discoid lupus erythematosus: the relationship of antibodies to single stranded DNA and other ANA subsets to clinical manifestations. J Am Acad Dermatol1985; 13: 748-55.
5.
Lehmann P., Holzle E., Kind P., Goerz G., Plewig G.Experimental reproduction of skin lesions of lupus erythematosus by UVA and UVB radiation. J Am Acad Dermatol1990; 22: 181-7.
6.
Dubois ELAntimalarials in the management of discoid and systemic lupus erythematosus . Semin Arthritis Rheum1978; 8: 33-51.
7.
Callen JPChronic cutaneous lupus erythematosus. Clinical, laboratory, therapeutic and prognostic examination of 62 patients. Arch Dermatol1982; 118: 412-6.
8.
Kraak JH, van Ketel WG, Prakken JR, van Zwet WRThe value of hydroxychloroquine (plaquenil) for the treatment of chronic discoid lupus erythematosus: a double blind trial. Dermatologica1965; 130: 293-305.
9.
The Canadian Hydroxychloroquine Study Group.A randomized study of the effect of withdrawing hydroxychloroquine sulfate in systemic lupus erythematosus. New Engl J Med1991; 324: 150-4.
10.
Tanenbaum L. , Tuffanelli DLAntimalarial agents chloroquine, hydroxychloroquine and quinacrine. Arch Dermatol1980; 116: 587-91.
11.
Easterbrook M.Ocular effects and safety of antimalarial agents. Am J Med1988; 85(4A): 23-9.
12.
MacKenzie AHDose requirements in long term therapy of rheumatoid arthritis with antimalarials. Am J Med1983 ; 75(1A): 40-5.
13.
Easterbrook M.The use of AMSLER grids in early chloroquine retinopathy. Ophthalmology1984; 91: 1368-72.
14.
Shornick JK , Formica N., Parke ALIsotretinoin for refractory lupus erythematosus . J Am Acad Dermatol1991 ; 24: 49-52.
15.
Rubenstien DJ, Huntley ACKeratotic lupus erythematosus: treatment with isotretinoin, J Am Acad Dermatol1986; 14: 910-4.
16.
Green SG, Piette WWSuccessful treatment of hypertrophic lupus erythematosus with isotretinoin . J Am Acad Dermatol1987; 17: 364-8.
17.
Ruzicka T., Meurer M., Braun-Falco O.Treatment of cutaneous lupus erythematosus. Acta Derm Venereol (Stockholm) 1985; 65: 324-9.
18.
Newton RC, Jorizzo JL, Solomon AR et al. Mechanism-oriented assessment of isotretinoin in chronic or subacute cutaneous lupus. Arch Dermatol1986 ; 112: 170-6.
19.
Ruzicka T., Meurer M., Bieber T.Efficiency of acitretin in the treatment of cutaneous lupus erythematosus . Arch Dermatol1988; 124: 897-902.
20.
Hall RP, Lawley TJ, Smith HR, Katz SIBullous eruption of systemic lupus erythematosus: dramatic response to dapsone therapy. Ann Intern Med1982; 97: 165-70.
21.
McCormack LS , Elgart ML, Turner MCAnnular subacute cutaneous lupus erythematosus responsive to dapsone. J Am Acad Dermatol1984; 11: 397-401.
22.
Fenton DA, Black MMLow dose dapsone in the treatment of subacute cutaneous lupus erythematosus . Clin Exp Dermatol1986; 11: 102-3.
Knop J., Bonsmann G., Happle R. et al. Thalidomide in the treatment of sixty cases of chronic discoid lupus erythematosus. Br J Dermatol1983; 108: 461-6.
33.
Grosshans E. , Illy G.Thalidomide therapy for inflammatory dermatoses . Int J Dermatol1984; 23: 598-602.
34.
Dalziel K., Going G., Cartwright PH, Marks R., Beveridge GW, Rowell NRTreatment of chronic discoid lupus erythematosus with an oral gold compound (auranofin). Br JDermatol1986; 115: 211-6.
35.
Schulz EJ, Menter MATreatment of discoid and subacute lupus erythematosus with cyclophosphamide . Br J Dermatol1971; 85(Suppl 7): 60-5.
36.
McCune WJ, Golbub J., Zeldes W., Bohlke P., Dunne R., Fox DAClinical and immunologic effects of monthly administration of intravenous cyclophosphamide in severe systemic lupus erythematosus. New Engl J Med1988; 318: 1423-31.
37.
Callen JPTreatment of cutaneous lesions in patients with lupus erythematosus . Dermatologic Clinics1990; 8: 355-65.
38.
Callen JP, Spencer LV, Burruss JB, Holtman J.Azathioprine: an effective, corticosteroid-sparing therapy for patients with recalcitrant cutaneous lupus erythematosus or with recalcitrant cutaneous leukocytoclastic vasculitis. Arch Dermatol1991; 127: 515-22.
Heule F., Van Joost T, Beukers R.Cyclosporine in the treatment of lupus erythematosus. Arch Dermatol1986; 122: 973-4 (letter).
41.
Nicolas J-F. , Thivolet J., Kanitakis J., Lyonnet S.Response of discoid and subacute cutaneous lupus erythematosus to recombinant interferon alpha 2A. J Invest Dermatol1990; 95: 142S-5S.
42.
Martinez J. , de Misa RF, Torrelo A., Ledo A.Low-dose intralesional interferon alfa for discoid lupus erythematosus. J Am Acad Dermatol1992; 26: 494-6.
43.
Knobler RM, Graninger W., Lindmaier A., Trautinger F., Smolen JSExtracorporeal photochemotherapy for the treatment of systemic lupus erythematosus . Arthritis Rheum1992; 35: 319-24.
44.
Graham WP III, Miller SH, Lapidus SMSkin grafting: diminishing the stigmata of lupus erythematosus. Pa Med1977; 80: 56-7.
45.
Ratner D., Skouge JWDiscoid lupus erythematosus scarring and dermabrasion: a case report and discussion . J Am Acad Dermatol1990; 22: 314-6.
46.
Zachariae H. , Bjering P., Cramers M.Argon laser treatment of cutaneous vascular lesions in connective tissue diseases. Acta Derm Venereol (Stockholm) 1988 ; 68: 179-82.
