Table 1.
A summary of treatment options for cutaneous lesions, in order of recommendation, distinct for each diagnostic category of cutaneous lupus. Abbreviations: CLE, cutaneous lupus erythematosus; ACLE, acute cutaneous lupus erythematosus; TEN, toxic epidermal necrolysis; IVIG, intravenous immunoglobulin; SCLE, subacute cutaneous lupus erythematosus; DLE, discoid lupus erythematosus; CHLE, chilblain lupus erythematosus; LE/LP overlap, lichenoid cutaneous lupus erythematosus-lichen planus overlap syndrome.
| Subset of CLE | Lineage of treatment options | Treatment of cutaneous manifestations |
|---|---|---|
| ACLE | First line | Sun protection Smoking cessation Topical steroids Topical calcineurin inhibitors Antimalarials |
| Second line | Oral corticosteroids | |
| TEN variant of ACLE | First line | Systemic corticosteroids |
| Second line | Antimalarials IVIG Mycophenolate mofetil |
|
| SCLE | First line | Sun protection Topical steroids Topical calcineurin inhibitors Antimalarials |
| Second line | Oral corticosteroids | |
| DLE | First line | Sun protection Smoking cessation Topical steroids (fluocinonide > hydrocortisone) Topical calcineurin inhibitors Monthly intralesional triamcinolone Antimalarials |
| Second line | Methotrexate Systemic retinoids Thalidomide Lenalidomide Dapsone Mycophenolate mofetil (adjuvant) Azathioprine IVIG Topical and systemic retinoids (hypertrophic DLE) |
|
| Tumid lupus | First line | Topical steroids Hydroxychloroquine, chloroquine |
| Lupus panniculitis | First line | Topical or intralesional steroids for overlying DLE Antimalarials Systemic corticosteroids for initial phases only |
| Second line | Dapsone Mycophenolate mofetil Cyclophosphamide Thalidomide IVIG |
|
| Third line | Rituximab | |
| CHLE | First line | Protection from the cold Antibiotics for necrotic areas |
| Second line | Topical steroids | |
| Third line | Systemic corticosteroids Calcium channel blockers |
|
| Fourth line | Mycophenolate mofetil Baricitinib Ruxolitinib |
|
| LE/LP overlap | First line | Topical tacrolimus Systemic retinoids Cyclosporine |
| Bullous lupus | First line | Dapsone |
| Second line | Systemic corticosteroids Antimalarials |
|
| Third line | Methotrexate Azathioprine Cyclophosphamide Mycophenolate mofetil |
|
| Fourth line | Rituximab | |
| Neonatal lupus | First line | Sun protection Laser therapy for residual telangiectasias |