About Cutaneous Lupus Erythematosus (CLE, Skin Lupus)

Overview

Cutaneous lupus erythematosus (CLE) is a skin disease that can occur in people with or without systemic lupus erythematosus (SLE). It is characterized by various symptoms such as rashes, hair loss, swelling of blood vessels, ulcers, and sensitivity to sunlight. CLE has two major types:

• Discoid lupus erythematosus (DLE): This type typically starts as a raised red rash that may become scaly or change color to dark brown. It often affects the face and scalp but can appear on other areas of the body. Scarring is common, and it can also cause sores in the mouth or nose. There is a small chance that DLE may progress to SLE.
• Subacute cutaneous lupus erythematosus (SCLE): This type causes skin lesions that appear on sun-exposed areas of the body. These lesions do not usually result in scarring.

To diagnose CLE, a small piece of the rash or sore is removed and examined under a microscope. Treatment options for CLE may vary depending on the severity of symptoms and can include medications to manage inflammation and protect the skin from sun exposure.

Causes and Risk Factors

The disease causes of CLE are not fully understood, but it is believed to involve an autoimmune response where the body's immune system mistakenly targets healthy skin cells. The exact triggers for this immune response are unknown, but factors such as genetic predisposition and environmental factors may play a role.

Non-modifiable risk factors for CLE cannot be changed or controlled. These include:

• Gender: CLE is more common in women than in men.
• Age: CLE can occur at any age, but it is most commonly diagnosed between the ages of 15 and 45.
• Family history: Having a family member with CLE or other autoimmune diseases increases the risk.

Modifiable risk factors—factors that can be influenced or changed—for CLE are not fully understood and need more research. However, some potential factors include:

• Sun exposure: Ultraviolet (UV) radiation from the sun can trigger or worsen CLE symptoms. It is important to protect your skin from the sun by wearing protective clothing, using sunscreen, and seeking shade.
• Smoking: Smoking has been associated with an increased risk of developing CLE and worsening of symptoms. Quitting smoking may help improve symptoms and reduce the risk of complications.

It's important to note that these modifiable risk factors are based on observational studies and more research is needed to establish a definitive link. As always, it's best to consult with your healthcare professional for personalized advice.

Symptoms

Cutaneous lupus erythematosus (CLE) can present with various symptoms depending on the stage and severity of the condition. Here are the most common early symptoms of CLE:

• Skin rashes: CLE often causes skin rashes, such as a discoid rash (thick, scaly patches that can leave scars) or subacute cutaneous lesions (red, ring-shaped or scaly patches). These rashes may change color or become scaly over time.

As CLE progresses or becomes more severe, additional symptoms may occur:

• Hair loss: Some individuals with CLE may experience hair loss, which can be patchy or more widespread.
• Swelling of blood vessels: CLE can cause swelling of the blood vessels, leading to a condition called vasculitis.
• Ulcers: In some cases, CLE can result in the formation of ulcers on the skin.
• Sun sensitivity: People with CLE may develop increased sensitivity to sunlight, leading to skin reactions when exposed to UV light.
• Scarring: In discoid lupus erythematosus (DLE), scarring is common and may occur in areas affected by rashes.
• Oral lesions: CLE can manifest as oral mucosal ulceration, causing painful ulcers in the mouth or nose.

It is important to note that these symptoms can vary from person to person, and not everyone with CLE will experience all of them. If you suspect you may have CLE or are experiencing any concerning symptoms, it is advisable to consult with a healthcare professional for an accurate diagnosis and appropriate management.

Diagnosis

To diagnose cutaneous lupus erythematosus (CLE), health care providers commonly perform the following examinations, tests, and procedures:

• Physical examination: The health care provider will examine the skin for lesions and note their type, spread, and location.
• Medical history: The health care provider will gather information about your medical history and any previous diagnoses.

Additional examinations, tests, and procedures to assess the severity and extent of CLE involvement may include:

• Lab tests: Blood and urine tests may be ordered to check for specific markers or autoantibodies associated with the disease. Autoantibodies are immune system proteins that mistakenly attack the body’s own tissues. These are common in CLE and can help confirm the diagnosis.
• Skin biopsy: A small sample of skin may be taken for further examination under a microscope.
• Imaging studies: Depending on your symptoms, imaging studies such as X-rays or MRI (magnetic resonance imaging) scans may be recommended to assess the extent of CLE involvement or associated complications.

It's important to consult with your health care provider about which specific examinations, tests, and procedures are necessary for your individual situation. They will determine the appropriate course of action based on your symptoms and medical history.

Treatment Options

The goals of treatment for cutaneous lupus erythematosus (CLE) are to manage symptoms, reduce inflammation, and improve the appearance of the skin. The following treatments may be recommended:

• Medications:
  • Steroid creams: These reduce inflammation in the affected areas of the skin.
  • Calcineurin inhibitors: They help reduce the side effects of steroids.
  • Antimalarial drugs: These can be effective in reducing skin symptoms and preventing flares.
  • Corticosteroid injections: These may be used for localized skin lesions.
• Therapies:
  • Phototherapy: This involves using ultraviolet light to treat skin lesions.
• Self-care and health behavior changes can help manage symptoms and improve skin appearance:
  • Sun protection: Wearing sunscreen, protective clothing, and avoiding excessive sun exposure can help prevent flare-ups.
  • Physical fitness exercises: Regular exercise has been shown to improve physical fitness, symptomatology, and health-related quality of life in patients with CLE.
  • Avoiding triggers.
  • Stopping smoking.

It's important to note that treatment options may vary depending on the severity and spread of CLE. Consult with a healthcare professional for personalized advice.

Medication dosing may be affected by many factors. Check with your health care professional about dosing for your individual situation. Side effects can occur. Check with your health care professional or read the information provided with your medication for side effect information.