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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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