Most common types of mucocutaneous lesions associated with SLE
- • Interface dermatitis is generally seen in rashes of SLE (but can also be seen indermatomyositis)
- • Biopsy can also demonstrate immunoglobulins deposited at dermal epidermal junctionon immunofluorescence (lupus band test)
- • Photo protection should be employed in all cutaneous lupus rashes
- • Controlling generalized SLE activity can be helpful but is not always successful
- • Hydroxychloroquine (with or without quinacrine) can be used for stubborn skin activity
- • Chloroquine 250 mg per day can be used as an alternative to hydroxychloroquine. Dapsone should be considered for all vesicular lupus skin lesions.
- • Consider thalidomide for severe mouth ulcerations (make sure to have birth control forpremenopausal females)
- • Belimumab has been used for recalcitrant discoid or subacute rashes
- • Consider methotrexate, mycophenolate mofetil, azathioprine, or rituximab as well
Less common rashes seen in SLE:
- • bullous lesions
- • palpable purpura due to small vessel vasculitis
- • urticaria that may also be due to small vessel vasculitis. Test for anti-C1q antibodies.
- • panniculitis with subcutaneous nodules (lupus profundus)
- • livedo reticularis (seen with antiphospholipid antibodies)
- • perniosis (distal vasculopathy)
Pearl : For severe SLE skin disease, consider a combination of hydroxychloroquine and quinacrine. The quinacrine must be made at a compounding pharmacy and paid for out of pocket. Patients sometimes develop a slight orange hue of the skin with these two therapies.
Pearl : Suspect a drug-induced cause for any patient aged >50 years who develops SCLE.