Cutaneous Lupus Erythematosus - Causes, Diagnosis, and Treatment

Introduction

Cutaneous lupus erythematosus is an autoimmune disorder characterized by various skin manifestations. Cutaneous lupus erythematosus symptoms include erythematous skin, usually presenting with a scaly rash. Sometimes, skin rashes due to cutaneous lupus erythematosus are often followed by sun exposure. It is also observed that cutaneous lupus erythematosus is more susceptible in females than in males. Cutaneous lupus erythematosus sometimes occurs in association with systemic lupus erythematosus. Cutaneous lupus erythematosus may appear due to various etiologies, including genetic and autoimmune factors, and due to an impaired immune system.

What Is Cutaneous Lupus Erythematosus?

Cutaneous lupus erythematosus is an autoimmune disorder causing various skin problems. Cutaneous lupus erythematosus is not a contagious condition, and the symptoms of cutaneous lupus erythematosus are triggered by sun exposure. The skin rash in cutaneous lupus erythematosus is due to the immune cells. The immune cells cause skin inflammation, and other factors may trigger the flare-ups in cutaneous lupus erythematosus episodes. Cutaneous lupus erythematosus can be differentiated into several subtypes. The several subtypes of cutaneous lupus erythematosus proposed by Gallium are mentioned below:

Acute Cutaneous Lupus Erythematosus: Acute cutaneous lupus erythematosus is the active form of cutaneous lupus erythematosus. Acute cutaneous lupus erythematosus has both localized and generalized forms. The localized form of acute cutaneous lupus erythematosus is characterized as the malar rash, typically like butterfly rash. A red rash is present on either side of the cheeks, nasal bridge, and in the nasolabial fold. Acute cutaneous lupus erythematosus lesions are transient and are induced by sun exposure. Scarring is absent in acute cutaneous lupus erythematosus. The generalized form of acute cutaneous lupus erythematosus typically presents with maculopapular rash, pruritus, and ulcers.

Subacute Cutaneous Lupus Erythematosus: Subacute cutaneous lupus erythematosus is common in middle-aged people, and women show a higher incidence rate than males. There are two variants of subacute cutaneous lupus erythematosus, and the two variants of subacute cutaneous lupus erythematosus are mentioned below. The skin lesions in subacute cutaneous lupus erythematosus are photosensitive.

• Annular subacute cutaneous lupus erythematosus includes annular scaly erythematous plaques. The erythematous scales coalesce into the polycyclic array.

• Papulosquamous subacute cutaneous lupus erythematosus present like eczema and psoriasis

Chronic Cutaneous Lupus Erythematosus: Chronic cutaneous lupus erythematosus has four variants, and the four variants of chronic cutaneous lupus erythematosus are mentioned below:

• Discoid Lupus Erythematosus: It is the most common variant among females. Symptoms of discoid lupus erythematosus are present in the neck, head, scalp, and in-ear regions. The lesions in desmoid lupus erythematosus include red macules and papules with well-demarcated scales. The scarring alopecia is present. The symptoms will be triggered by any trauma and sun exposure.

• Lupus Erythematosus Profundus: It is also referred to as panniculitis. Lupus erythematosus profundus might cause chronic symptoms. The firm subcutaneous nodules are present in association with pain.

• Chilblain Lupus Erythematosus: It is a rare variant of chronic cutaneous lupus erythematosus. The symptoms of this type of variant resemble frostbite, including pain, violet plaques, nodules, erosions, and ulcers seen in the fingers, heels, nose, toes, and ears.

• Lupus Erythematosus Tumidus: It is most common in men and follows a benign course. The skin lesions in this variant are primarily observed in the face, and the other features, including erythema, edema, and urticaria, are present.

What Are the Causes of Cutaneous Lupus Erythematosus?

It is suggested that various factors cause cutaneous lupus erythematosus. Some of the proposed etiologies of cutaneous lupus erythematosus are mentioned below:

• Genetic factor.

• Environmental factors such as smoking cigarettes.

• Sun exposure.

• Medications.

• Autoimmune response.

What Is the Diagnosis of Cutaneous Lupus Erythematosus?

There are various diagnostic tools available for diagnosing cutaneous lupus erythematosus. The physical examination for evaluating the symptoms and other test reports forms the diagnosis of cutaneous lupus erythematosus. The diagnostic measures of cutaneous lupus erythematosus are mentioned below:

• History of the patient.

• Personal history.

• Physical examination.

• Lab studies.

• Skin biopsy.

• Serology tests include complete blood tests.

• Direct immunofluorescence test.

• Renal analysis should be done to evaluate serum creatinine and serum urea.

• Urine analysis must be done.

What Are the Differential Diagnoses of Cutaneous Lupus Erythematosus?

The signs and symptoms of cutaneous lupus erythematosus are similar to other autoimmune disorders. The diagnosis should be carefully made without giving a chance for misdiagnosis. Some of the differential diagnoses of cutaneous lupus erythematosus are mentioned below:

• Rheumatoid arthritis.

• Sjogren's syndrome (a long-lasting autoimmune disorder that occurs when the immune system attacks the glands that are responsible for secreting moisture in the mouth, eyes, and other parts of the body).

• Leprosy.

• Dermatomyositis.

• Scleroderma.

• Keratoacanthoma,

• Hypertrophic lichen planus.

• Tinea corporis.

• Erythema annulare centrifugum.

What Is the Treatment of Cutaneous Lupus Erythematosus?

Triggers of cutaneous lupus erythematosus are avoided to prevent the cutaneous lupus erythematosus. The treatment is mainly done to reduce these symptoms. The treatment modes of cutaneous lupus erythematosus are mentioned below:

• Preventive Management: Skin lesions of cutaneous lupus erythematosus are triggered by sun exposure. By applying sunscreen, the triggers can be avoided.

• Topical Therapy: This includes topical fluocinonide 0.05 %, Hydrocortisone cream 1 %, Fluocinolone acetonide 0.01 %, Clobetasol cream, Calcineurin inhibitors, and topical Tacrolimus 0.1 %.

• Physical Therapy: This includes laser therapy, cryotherapy, and dermabrasion.

• Systemic Therapy: This includes antimalarial therapy, systemic corticosteroids, immunosuppressants, biologics, immunomodulators, and oral retinoids.

Conclusion

Cutaneous lupus erythematosus is an autoimmune skin disorder characterized by a red rash commonly associated with systemic lupus erythematosus. Cutaneous lupus erythematosus has various subtypes, and the skin lesion can be triggered by some factors. The diagnosis is confirmed, and the advised treatment is continued. Preventive management is followed, and smoking cessation can improve the quality of life.