Guideline for the Diagnosis, Treatment, and Long-Term Management of CLE

September 8, 2021

An international group of researchers, including UPMC’s Amr Sawalha, MD, recently published “Guideline for the Diagnosis, Treatment and Long-Term Management of Cutaneous Lupus Erythematosus” in the Journal of Autoimmunity.

Cutaneous lupus erythematosus (CLE) is an inflammatory autoimmune disease with a variety of subtypes. Correct diagnosis of CLE, specifically in rare subtypes, can be challenging for physicians due to the complexity of classification. 

To give dermatologists and rheumatologists a comprehensive guide for the diagnosis and management of CLE, this group of researchers consisting of dermatologists, rheumatologists, research scientists, and methodologists developed evidence-based guidelines and recommendations. 

Recommendations

Diagnosis

Authors recommend excluding systemic lupus erythematous (SLE) before making a diagnosis of CLE and an assessment of disease activity and damage of CLE before and during treatment. 
Since there are no standard diagnostic criteria for all subtypes of CLE, diagnosis should consist of a comprehensive patient history, clinical manifestation, lab work, and skin biopsy. 

Protective Measures

For protective measures, authors recommend avoidance of UV and sunlight exposure, cessation of smoking, and performance of a thorough history of medications. Patients with a history of Koebner phenomenon should avoid trauma, surgery, cryotherapy, and invasive laser treatment of the skin.

Localized and Systemic Treatments

For topical and localized treatments, authors suggest topical corticosteroids for short-term treatment and intralesional injection of corticosteroids for localized, refractory discoid lupus erythematosus as first line options.

For widespread, severe, or topical treatment-resistant CLE, systemic treatment including antimalarials or corticosteroids can be used. Antimalarials are first-line treatment and are safe for pregnant patients and pediatric patients. 

Disease Management

Due to CLE’s chronic and relapsing course, long-term disease monitoring is necessary. Frequency can be adjusted based on the severity and activity of the disease, the patient’s clinical condition, and the response to medication. 

Read the full set of guidelines here.

Reference

Qianjin Lu, Hai Long, Steven Chow, Syarief Hidayat, Retno Danarti, Yulianto Listiawan, Danqi Deng, Qing Guo, Hong Fang, Juan Tao, Ming Zhao, Leihong Xiang, Nan Che, Fen Li, Hongjun Zhao, Chak Sing Lau, Fong Cheng Ip, King Man Ho, Arnelfa C. Paliza, Chan Vicheth, Kiran Godse, Soyun Cho, Chew Swee Seow, Yoshiki Miyachi, Tran Hau Khang, Rataporn Ungpakorn, Hassan Galadari, Rashmikant Shah, Kehu Yang, Youwen Zhou, Carlo Selmi, Amr H. Sawalha, Xuan Zhang, Yaolong Chen, Chrang-Shi Lin. Guideline for the diagnosis, treatment and long-term management of cutaneous lupus erythematosus. Journal of Autoimmunity. Volume 123, 2021; 102707. ISSN 0896-8411. https://doi.org/10.1016/j.jaut.2021.102707.