Management of cutaneous lupus erythematosus

The treatment strategy for cutaneous lupus erythematosus (CLE) depends on the extent of skin disease, the likelihood of damage, and the response to therapy. Photoprotection, topical glucocorticoids and calcineurin inhibitors, and intralesional steroids can be used in patients with mild disease. Oral antimalarials, including hydroxychloroquine, quinacrine, and chloroquine, are first-line treatments for patients with moderate or severe CLE disease. Prednisone can be provided short term to these patients for rapid relief of symptoms, but other steroid-sparing agents are preferred for long-term treatment. Patients with moderate, severe, or refractory disease can be treated with immunosuppressives, including azathioprine, methotrexate, mycophenolate mofetil, thalidomide, lenalidomide, dapsone, retinoids, dapsone, or intravenous immunoglobulin as alternative treatments for CLE. Biologicals including rituximab and belimumab may play a role in selected cases.