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Dermatologists at UT Southwestern Medical Center have advanced training and years of experience caring for people with cutaneous lupus, an autoimmune skin disorder. Our dermatology specialists are skilled at tailoring medication options to treat each patient’s specific symptoms.
Advanced Care for Cutaneous Lupus
About two-thirds of people with lupus, a systemic autoimmune disease, develop a skin disorder called cutaneous lupus erythematosus. Autoimmune diseases develop when the immune system mistakenly attacks healthy tissues such as, in this case, the skin. Not everyone with cutaneous lupus has systemic lupus, and not every patient with systemic lupus will develop cutaneous lupus.
Dermatologists at UT Southwestern are well-known for their expertise in diagnosing and treating complex autoimmune skin disorders such as cutaneous lupus. We offer the latest advances in diagnosis and treatment, providing compassionate care that helps patients get back to the activities they enjoy.
Types of Cutaneous Lupus
The three major types of cutaneous lupus erythematosus are:
- Acute cutaneous lupus: Often a sign of systemic lupus, this flat, red, itchy, butterfly-shaped rash most commonly occurs on the nose and cheeks (or the malar area) but can develop on the arms, legs, or other areas. This rash often comes and goes, occurring during flares of systemic lupus. It usually resolves without any skin pigment changes or scarring.
- Subacute cutaneous lupus: This condition can develop on its own or with systemic lupus, and it can cause two types of lesions. One appears as patches of red, scaly skin with distinct edges that most commonly appear on sun-exposed areas such as the neck, shoulders, and arms. The other is flat, red, ring-shaped lesions that usually appear on the body but rarely the face. These lesions typically last longer than the acute cutaneous lupus rash.
- Chronic cutaneous lupus: This group consists of multiple subtypes of cutaneous lupus, including discoid lupus (the most common), tumid lupus, lupus profundus, and chilblain’s lupus. Chronic cutaneous lupus often has a prolonged course, with round lesions that are usually thick, pink or red, and scaly, resulting in scarring alopecia and areas showing alterations in skin pigment. These lesions typically occur on the face, ears, and scalp.
Causes of Cutaneous Lupus
Cutaneous lupus is caused by an autoimmune response, but the exact causes of the underlying autoimmune response are unknown. Certain factors can trigger cutaneous lupus, such as:
- Certain medications
- Exposure to sunlight
Symptoms of Cutaneous Lupus
The main symptoms of cutaneous lupus are the skin changes described above that occur with each variation of the condition. Other symptoms that can occur include:
- Itchiness in the skin
- Burning in the skin
- Pain in the skin
Diagnosis of Cutaneous Lupus
Our experienced dermatologists are skilled at evaluating symptoms to confirm a diagnosis. We begin with a thorough evaluation that includes a:
- Physical exam
- Review of personal and family medical history
- Discussion of symptoms
To confirm a diagnosis of a specific type of cutaneous lupus, we usually recommend further testing, which might include:
- Blood tests: Tests that check for inflammation or antibodies
- Skin biopsy: Removal of a small sample of affected skin to examine under a microscope for signs of disease
- Direct immunofluorescence: A test that uses special dyes to stain the skin biopsy sample and test it for antibodies
Treatment for Cutaneous Lupus
Although cutaneous lupus currently has no cure, treatment can manage symptoms. Our dermatologists prescribe medications such as:
- Corticosteroids to relieve inflammation, burning, itching, redness, and swelling. The types of steroid medications we use include:
- Topical corticosteroids, which are creams or gels that patients apply once or twice daily to the affected areas
- Injectable corticosteroids for larger lesions to ensure that medication reaches deeper layers, where it can work to improve skin lesions and provide symptomatic relief
- Oral corticosteroids such as prednisone, typically reserved for severe disease
- Antimalarial medications, such as hydroxychloroquine, chloroquine, and quinacrine, to reduce inflammation
- Immunosuppressants, such as mycophenolate mofetil, azathioprine, and methotrexate, to reduce immune response in patients with severe disease that hasn’t improved with other treatments
Our specialists also recommend minimizing sun exposure through lifestyle changes such as:
- Applying sunscreen with a sun protection factor (SPF) of 30 or higher
- Wearing sun-protective clothing
- Avoiding sun exposure between 10 a.m. and 4 p.m.
The Lupus Foundation of America is a national organization that aims to improve quality of life in patients with a diagnosis of lupus through research, education, support, and advocacy. Its website – lupus.org – provides information, resources, and ways for patients to connect to local and national support networks.
The organization has a local chapter in Dallas, Texas, called the Lone Star Chapter (lupus.org/lonestar). This chapter provides resources both for lupus patients and their caregivers, including information about understanding, treating, coping, and living with lupus. It has many ways for patients to get involved, such as joining the Walk to End Lupus Now, the Advocacy committee, an educational seminar, or a support group. It also has information to help patients find physicians and resources in their local Texas community and news about ongoing nearby clinical trials.
Clinical Research for Cutaneous Lupus
Dermatologists at UT Southwestern are establishing a national registry for patients with cutaneous lupus and their relatives. Our goal is to gather a large number of patients necessary for studies to better understand the development of the disease and improve our methods of diagnosis, prognosis, and treatment.
This registry is a significant advancement in cutaneous lupus research and will provide a resource for investigators to make discoveries in both the clinical and genetic aspects of the disease. Patients enrolled in the study will be first in line for clinical trials conducted at UT Southwestern for cutaneous lupus.
Patients with cutaneous lupus are at risk for developing systemic lupus erythematosus, even if they do not have this at diagnosis. No medication that been shown to prevent this progression. There is currently a randomized controlled trial looking at whether hydroxychloroquine can delay this development in patients at risk for developing systemic lupus. We encourage patients who are interested in learning more about this trial to call 214-648-7219 or email us.
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Fort Worth, Texas 76104 817-882-2460