Subacute Cutaneous Lupus Erythematosus |
In certain patients an elevated ESR and a positive rheumatoid factor with decreased complement levels can be seen. In addition, anemia, leukopenia, or thrombocytopenia may be present. A urinalysis should be done and must be performed periodically throughout the patient's clinical course. A biopsy on unaffected skin can be performed on sun-exposed or non-exposed locations. Testing of this normal area of skin is called the lupus band test (LBT). A biopsy of affected skin shows the distinctive histopathology of vacuolar alteration of the basal cell layer and an inflammatory lymphocytic cell infiltrate around vessels and appendiceal structures, as well as in the sub-epidermis. The most effective treatment for SCLE is sun protection in the form of a broad spectrum sunscreen and protective clothing. Corticosteroids topically or intralesionally can be used, as well as antimalarials such as hydroxychloroquine which has decreased efficacy in patients who smoke. Patients should however, avoid the use of systemic corticosteroids unless the patient experiences systemic disease or requires short term use. In addition, certain patients can benefit from the use of dapsone, thalidomide, interferon, systemic retinoids and immunosuppressive agents. Lastly, select patients with SCLE have been found to have low levels of vitamin D and should be advised to begin taking vitamin D and calcium supplementation.
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2018 AOCD Fall Current Concepts in Dermatology Meeting
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