Lupus erythematosus (LE) is a complex disease of autoimmune origin with a wide variety of manifestations. One of the most frequent is in the skin.
When a patient presents at the dermatologist’s office with lupus erythematosus lesions, it may be only a skin lesion or a manifestation of a systemic disease with possible involvement of internal organs. This is what we call systemic lupus erythematosus or SLE. In fact the skin is the second most affected quadrant in patients with SLE, and skin lesions represent 4 of the 11 diagnostic criteria for SLE.
Skin manifestations
The cutaneous manifestations of lupus erythematosus are highly variable and include among others: Discoid LE, tumid LE, photosensitivity, alopecia, lupus panniculitis, lupus perniosis, cutaneous vasculitis, urticaria-vasculitis, white atrophy, Raynaud’s phenomenon, etc. The clinical appearance of the lesions is very variable and can be confused with numerous skin diseases. Therefore, in order to make the diagnosis it is essential to perform biopsies of the skin lesions and to perform the appropriate analytical studies to rule out SLE.
Topical and systemic treatment
Treatment of LE includes important general measures such as sun avoidance, use of broad-spectrum photoprotectors and smoking cessation, since smoking worsens the skin lesions of LE and can cause treatment failure. If the LE is exclusively cutaneous and with few lesions, it can be adequately treated with topical medications alone (high potency corticosteroids and immunomodulators).
Extensive forms of cutaneous LE and SLE will also require the use of systemic drugs such as antimalarials (chloroquine, hydroxychloroquine), systemic corticosteroids and immunosuppressants. Among the latter, the recent incorporation of mycophenolate to the therapeutic arsenal (a drug that comes from transplant medicine) stands out and is providing very good results.