Subacute Cutaneous Lupus

What is subacute cutaneous lupus?

There are several variants of cutaneous lupus. Subacute cutaneous lupus erythematosus (SCLE) is one type of cutaneous lupus. Cutaneous is a term for skin. Cutaneous lupus includes the types of lupus that affect your skin.

People with SCLE develop skin rashes or lesions (sores). “Subacute” refers to the depth of inflammation seen with a skin biopsy.

What is lupus?

When people refer to lupus, they usually mean systemic lupus erythematosus (SLE). SLE is an autoimmune disease in which your immune system attacks its own tissues, causing inflammation and damage. SLE is the most common form of lupus and typically affects more than one organ.

Some people have SLE without skin involvement. Others will have cutaneous lupus without the systemic manifestations of SLE.

What are the types of cutaneous lupus?

There are three types of cutaneous lupus. Each type causes different skin rashes:

• Discoid lupus most commonly causes inflamed, thick raised plaques with scale on your face, head and neck.
• Subacute cutaneous lupus often creates red, ring-shaped or raised lesions on your neck, back or chest.
• Acute cutaneous lupus has been termed the “butterfly rash” because it causes a red rash on your cheeks and nose that resembles butterfly wings.

Can you have both SCLE and SLE?

Most people who have SCLE do not have SLE. However, people with SCLE may have systemic symptoms such as arthritis.

How common is cutaneous lupus?

It's hard to estimate how many people have cutaneous lupus. The Lupus Foundation of America estimates approximately 1.5 million Americans and at least 5 million people worldwide have a form of lupus. Lupus is much more common in women of child bearing age.

What causes SCLE?

The cause of SCLE is complex. It likely involves genetic factors as well as environmental factors such as ultraviolet radiation, medications, tobacco use and possibly infections.

In up to 20% to 30% of people with SCLE, the condition develops after taking certain medications. Common medications include:

• Anti-fungal medications.
• Blood pressure medications.
• Chemotherapy medications.
• Proton pump inhibitors.
• Tumor necrosis factor inhibitors.

Who might get subacute cutaneous lupus?

Lupus has a strong genetic component, meaning it runs in families. Lupus is more common in:

• Females.
• Ages 15 to 44.
• Black Americans.

What are the symptoms of subacute cutaneous lupus?

Subacute cutaneous lupus causes a rash. The rash typically occurs on sun-exposed areas of your body, such as your neck, chest, back and arms. The rash can look like:

• Red, ring-shaped, raised lesions that can form interlocking circles.
• Red, raised, dry skin that resembles a psoriasis rash.

The rash typically does not itch or scar. However, when the rash resolves, it may leave skin discoloration.

How is acute subcutaneous lupus diagnosed?

A dermatologist (a physician specializing in skin, hair and nails) can diagnose subacute cutaneous lupus with a skin biopsy. During a biopsy, your dermatologist removes a small sample of skin. The skin is sent to a laboratory to be examined under a microscope. This examination can determine whether a skin rash is due to lupus or another condition.

How is subacute cutaneous lupus treated?

Depending on how severe your symptoms are, your healthcare provider may recommend topical or oral medications.

Treatments may include:

• Sun protection: Apply a broad-spectrum sunscreen of SPF 30 or higher when you're out in the sun.
• Topical steroids: Hydrocortisone, triamcinolone, desoximetasone, etc.
• Topical calcineurin inhibitors: Tacrolimus and pimecrolimus.
• Oral antimalarial medications: Hydroxychloroquine and chloroquine.
• Oral immunosuppressive medications: Methotrexate, mycophenilate mofetil, azathioprine, etc.
• Anti-inflammatory drugs: Dapsone, sulfasalazine, etc.

How can I manage an SCLE rash flare?

SCLE rash flares are typically caused by certain triggers. Most commonly, lupus flares occur after exposure to ultraviolet (UV) light.

To protect yourself from UV exposure:

• Apply a broad-spectrum sunscreen with at least SPF 30 every day.
• Avoid sunlight when the sun is strongest, between 10 a.m. and 4 p.m.
• Refrain from using tanning beds.
• Wear sun-protective clothing, such as wide-brimmed hats and long sleeves when outside.

How can I prevent subacute cutaneous lupus?

There is no way to prevent subacute cutaneous lupus. To decrease the frequency and severity of skin rashes:

• Avoid and protect yourself from the sun.
• Speak with your healthcare provider about all medications that could increase your chances of SCLE.

What is the outlook for people with subacute cutaneous lupus?

Subacute cutaneous lupus is a lifelong (chronic) condition that waxes and wanes. Your outlook depends on if you have systemic involvement.

What else should I ask my healthcare provider?

• What is the most likely cause of SCLE?
• Am I likely to develop systemic lupus erythematosus?
• How can I prevent SCLE lesions from developing?
• How can I treat existing skin lesions?

A note from Cleveland Clinic

Subacute cutaneous lupus causes a rash. Usually, SCLE affects sun-exposed areas of the body, such as your neck, chest, back and arms. Your healthcare provider may prescribe medications to treat lupus. You can also limit flares by avoiding sun exposure. Subacute cutaneous lupus is a lifelong condition. With treatment, many people can prevent severe flares.