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Subacute Cutaneous Lupus
Erythematosus
Definition
Subacute Cutaneous Lupus Erythematosus
(SCLE) is a non-scarring photosensitive skin disorder.
Cause
While the exact cause is
not known, patients with SCLE 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.
Symptoms
The papulosquamous variety
of 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.
Diagnosis
If SCLE is suspected a
biopsy of the lesions may be done.
Blood work may
include ANA (positive
in most SCLE patients), Anti-Ro (SSA) (positive in about 70%),
Anti-La (SSB), Anti-dsDNA, CBC,
sedimentation rate (may be
elevated), RA factor (may be positive), and
complement
levels (may be low).
Treatment
The most important thing
for SCLE patients is avoidance of UV light. Use of sun
block, protective clothing and avoiding sunlight and tanning
beds is very important. Topical corticosteroids may be
used as well as corticosteroid injections. Sometimes
antimalarials are also used. Retinoid drugs such as
isotretinoin (Accutane), etretinate (Tegison), and acitretin
(Soriatane) are some times used in resistant cases. If SCLE is drug induced, the
offending medication should be discontinued under the advice of
a doctor.
Immunosuppressants such as Methotrexate and cyclophosphamide
(Cytoxan) may be used for potentially disabling cases.
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