Subacute Cutaneous Lupus Erythematosus

What is Subacute Cutaneous Lupus Erythematosus ?

Lupus erythematosus (LE) is a type of disorder that causes inflammation in your connective tissues. It’s associated with harmful self-attacking antibodies, which are parts of your immune system. These antibodies can create immune complexes that get deposited in your tissues, and this usually happens because your immune system has stopped recognizing your own body’s cells. Skin problems are one of the ways that lupus can show up and help doctors diagnose the condition.

There’s a wide range of skin problems that can be caused by lupus, and they could happen along with other symptoms of lupus or on their own. These skin issues can be classified as either specific to lupus or not specific to lupus. Lupus-specific problems are further divided into several types, with three main types identified by researcher Gillian and colleagues: acute cutaneous lupus, subacute cutaneous lupus, and chronic cutaneous lupus erythematosus.

In this discussion, we’ll talk about subacute cutaneous lupus erythematosus (SCLE). SCLE is a type of lupus that affects the skin. It usually presents as a red, non-damaging rash that’s sensitive to light and often appears symmetrically on parts of the body that are commonly exposed to the sun, like the face, neck, arms, upper back, and shoulders.

What Causes Subacute Cutaneous Lupus Erythematosus ?

The exact cause of systemic lupus erythematosus, a disease that affects the immune system, isn’t fully understood. Typically, it’s thought that exposure to sunlight can trigger the disease in those who are already at risk due to a combination of genetic factors and an abnormal immune response. Certain medications can also lead to a specific type of lupus known as subacute cutaneous lupus erythematosus (SCLE).

Some of the drugs that have been linked to SCLE include angiotensin-converting enzyme inhibitors (medications used to lower blood pressure), anticonvulsants (used to prevent seizures), beta-blockers (another type of blood pressure medication), and immune modulating drugs (these affect how the immune system works), including ones that inhibit a protein in the body called TNF alpha.

There have also been cases where SCLE has developed in people with certain types of cancer.

Risk Factors and Frequency for Subacute Cutaneous Lupus Erythematosus

Systemic lupus erythematosus is a disease that usually happens in young to middle-aged women, who are 3 to 4 times more likely to develop it compared to men. Most often, people start showing signs in their 30s or 40s. On average, patients start experiencing this condition between the ages of 50 and 52. The condition often makes the skin extremely sensitive to light, affecting about 48% to 90% of patients. While the disease can be caused by certain medications and can occur in both men and women and at older ages, it’s most common in women.

• Systemic lupus erythematosus often affects young to middle-aged women, who are 3 to 4 times more likely to develop the condition than men.
• The disease typically first appears in the third or fourth decade of life.
• The average age of onset is between 50 and 52.
• The disease makes around 48% to 90% of patients highly sensitive to sunlight.
• Medications can sometimes cause this disease, which can then appear in either sex and at older ages.

Signs and Symptoms of Subacute Cutaneous Lupus Erythematosus

Systemic lupus erythematosus, or SCLE, often leads to two types of skin issues: small, raised, scaly spots (papulosquamous lesions) or circular marks with clear centers (annular lesions). Often, people with SCLE have both types at once. These lesions don’t usually leave scars or cause skin thinning (atrophy) once they heal, but they may cause areas of lighter skin color (hypopigmentation) or clusters of tiny, dilated blood vessels (telangiectasia). However, in most cases, the skin goes back to normal after the lesions heal.

People with SCLE usually have mild symptoms, excluding joint discomfort and abnormal blood tests. The skin lesions are more likely to appear on areas of the body that see more sunlight, such as the neck, shoulders, chest, and the top of the arms. Interestingly, the face is usually not affected by these lesions.

Testing for Subacute Cutaneous Lupus Erythematosus

Systemic lupus erythematosus (SLE), and other types of Cutaneous lupus erythematosus (CLE), are usually diagnosed based on the signs and symptoms observed by the doctor. When the diagnosis isn’t clear, a skin biopsy (a process where a small skin sample is taken for examination) might be recommended to confirm the condition.

Your doctor might also suggest specific lab tests, such as anti-SSA/Ro and anti-SSB/La. These tests detect the presence of certain antibodies (proteins our body produces to fight foreign substances), commonly found in patients with lupus.

Another technique that can provide additional evidence to support a lupus diagnosis is ‘Direct Immunofluorescence.’ This method identifies a pattern of protein deposits, known as immunoglobulin, present at the junction between the upper (epidermal) and lower (dermal) layers of your skin. This finding is often seen in people with lupus.

Treatment Options for Subacute Cutaneous Lupus Erythematosus

Managing systemic lupus erythematosus (SLE), an autoimmune disease that impacts various parts of the body, involves a combination of lifestyle changes and medication. It’s important for those with SLE to take care of their physical health, for example, by wearing sun-protective clothing and hats, as well as using sunscreen. This is because SLE patients may have increased sensitivity to sun exposure, which could trigger a flare-up of symptoms. Applying a broad-spectrum sunscreen with a sun protection factor (SPF) of at least 50 about 20 to 30 minutes before going outside can provide the necessary protection.

Another important lifestyle change is to quit smoking, as tobacco can make SLE symptoms worse.

When it comes to medications, the first-line treatment usually involves topical corticosteroids and calcineurin inhibitors. These medicines help reduce inflammation and calm the immune system. If a patient’s skin condition doesn’t improve with these treatments, or if the disease affects a large area of the body, doctors may consider systemic therapy, which involves medication that works throughout the entire body.

Patients with SLE are typically started on antimalarials like hydroxychloroquine, chloroquine, or quinacrine. These medicines not only offer sun protection but also have anti-inflammatory properties that can help control symptoms of SLE.

In cases where patients don’t respond to initial treatments, additional medications that suppress the immune system might be used, such as methotrexate, dapsone, mycophenolate, azathioprine, and thalidomide. These can help in reducing the body’s immune response and thus, the symptoms of SLE.

Moreover, belimumab and dapsone are considered alternatives if the above treatments are insufficient. Another option for managing SLE includes intravenous immunoglobulin (IVIG), which can be used in severe cases that are resistant to conventional treatment. These approaches can offer promising results in bringing relief to patients with SLE. It’s crucial to remember that these treatments should be followed under the supervision of a healthcare professional, who will monitor for any side effects and adjust treatment according to the patient’s individual needs.

What else can Subacute Cutaneous Lupus Erythematosus be?

When dealing with certain skin conditions, it’s important that doctors rule out other similar conditions as well. Some of these may include:

• Psoriasis
• Tinea corporis (ringworm of the body)
• Nummular eczema (circular patches of irritated skin)
• Dermatomyositis (inflammation of the muscles)
• Pityriasis rubra pilaris (uncommon skin disorder that causes red, flaky skin)
• Sarcoidosis (inflammation that produces small lumps of cells in various organs)
• Cutaneous T cell lymphoma (cancer of a type of white blood cells that affects the skin)
• Drug eruptions (adverse skin reactions to drugs)

What to expect with Subacute Cutaneous Lupus Erythematosus

Systemic lupus erythematosus, commonly known as lupus, is a condition which can cause a rash that reacts to sunlight. Around half of the people who experience a specific type of this rash, known as SCLE, could also be categorized as having lupus. However, for these individuals, symptoms of lupus, such as joint pain, muscle pain, mouth ulcers, and certain blood test results (antinuclear antibody or ANA, anti-double stranded DNA or anti-dsDNA, and low levels of complement proteins in the blood), tend to be mild. Severe systemic disease is less commonly seen.

Involvement of the central nervous system (the brain and spinal cord), blood vessel inflammation (vasculitis), or kidney inflammation (nephritis), might occur in about 10% of patients. Also, kidney disease has been linked to certain variants of SCLE, which present as scaly skin lesions.

Possible Complications When Diagnosed with Subacute Cutaneous Lupus Erythematosus

Using sun protection can sometimes lead to a deficiency in vitamin D. Also, a rare condition known as systemic lupus erythematosus can cause great discomfort by impacting large skin surface areas, possibly affecting one’s quality of life. The complications of systemic cutaneous lupus erythematosus can even influence major organs, leading to further health issues.

Potential Issues:

• Vitamin D deficiency due to sun protection
• Discomfort from systemic lupus erythematosus
• Decreased quality of life
• Complications from systemic cutaneous lupus erythematosus
• Involvement of vital organs

Preventing Subacute Cutaneous Lupus Erythematosus

Doctors should advise their patients about ways to protect their skin from the sun, how to quit smoking, and how to correct inadequate levels of vitamin D in their body. It’s also essential for patients to stay away from any medications that could cause or worsen subacute cutaneous lupus erythematosus (SCLE), a type of skin condition associated with inflammation and red patches.