Subacute Cutaneous Lupus (SCLE)

What is subacute cutaneous lupus?

Subacute cutaneous lupus erythematosus (SCLE) is one form of cutaneous lupus erythematosus (CLE), which is a type of lupus that affects your skin. People with SCLE develop red, ring-shaped or raised lesions on their neck, shoulders, arms, back or chest. “Subacute” refers to the depth of inflammation seen with a skin biopsy. About half of people with subacute cutaneous lupus also have the more common form of lupus, systemic lupus erythematosus (SLE).

Subacute cutaneous lupus can be tricky to understand. Like other forms of lupus, it can look and act differently for everyone who has it. That can make it hard to diagnose. Look for a healthcare provider who will listen to your concerns and help you find treatment to manage the condition. It may also be helpful to look for support groups in your area or online. By listening to the experiences of others with the condition, you may feel more empowered to manage the disease.

What are the different subtypes of subacute cutaneous lupus (SCLE)?

The subtypes of SCLE include:

• Annular SCLE. This rash consists of red, raised, ring-shaped plaques that spread across sun-exposed areas. When they heal, they leave areas of lightened skin (hypopigmentation).
• Papulosquamous SCLE. This rash combines bumps (papules) with scales (squamous). It may resemble eczema or psoriasis. It’s triggered by sunlight and appears on sun-exposed areas

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, like your neck, chest, back and arms. The rash can look like:

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

The rash typically doesn’t itch or scar. But when the rash resolves, it may leave skin discoloration.

What causes SCLE?

The cause of SCLE is complex. Researchers believe it likely involves genetic factors as well as environmental factors like ultraviolet radiation, medications, tobacco use and pesticides.

In about one-third of people with SCLE, the condition develops after taking certain medications like:

• Anti-fungal medications.
• Anti-seizure medications.
• Blood pressure medications.
• Chemotherapy medications.
• ACE inhibitors.
• Proton pump inhibitors (PPIs).
• Tumor necrosis factor inhibitors.

What are the risk factors for subacute cutaneous lupus?

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

• People assigned female at birth (AFAB).
• People between the ages of 40 and 60.
• White people.

What are the complications of SCLE?

Because people with subacute cutaneous lupus have to protect themselves from the sun so much, they may end up developing a vitamin D deficiency. In addition, the condition can lead to extreme discomfort and may affect your quality of life.

How is subacute cutaneous lupus diagnosed?

A dermatologist (a doctor specializing in skin, hair and nails) or a rheumatologist (a doctor specializing in arthritis) can diagnose subacute cutaneous lupus. Your provider will perform a physical examination and ask you about your symptoms. In addition, they may request a skin biopsy. During a biopsy, your provider 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.

What tests will be done to diagnose subacute cutaneous lupus?

If your healthcare provider suspects SCLE, they may request additional tests to confirm their diagnosis. These tests may include:

• Complete blood count (CBC).
• Sed rate (erythrocyte sedimentation rate test).
• C-reactive protein (CRP) test.
• Antinuclear antibody (ANA) test.
• Liver function tests.
• Kidney function tests.
• Urinalysis.

How is subacute cutaneous lupus treated?

The most important treatment for SCLE is sun protection. Make sure to apply a broad-spectrum sunscreen of SPF 50 or higher when you’re out in the sun.

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

Treatments may include:

• Topical steroids: Hydrocortisone, triamcinolone, desoximetasone and clobetasol.
• Topical calcineurin inhibitors: Tacrolimus and pimecrolimus.
• Oral antimalarial medications: Hydroxychloroquine, chloroquine and quinacrine.
• Oral immunosuppressive medications: Methotrexate, mycophenilate mofetil, azathioprine and thalidomide.
• Oral retinoids: Acitretin and isotretinoin.
• Anti-inflammatory drugs: Dapsone and sulfasalazine.
• Monoclonal antibodies: Immunoglobulin (IVIG), rituximab and belimumab.

How can I prevent subacute cutaneous lupus?

You can’t prevent subacute cutaneous lupus. To decrease the frequency and severity of skin rashes:

• Take a vitamin D supplement.
• Don’t smoke.
• Speak with your healthcare provider about all medications that could increase your chances of SCLE.

Certain triggers typically cause SCLE rash flares. 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 50 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, like wide-brimmed hats and long sleeves when outside.

What is the outlook for people with subacute cutaneous lupus?

Subacute cutaneous lupus is a lifelong (chronic) condition that waxes and wanes. You’ll have to work with your healthcare provider to determine which treatment options help relieve your symptoms. It’s also important to protect yourself from the sun to avoid symptom flare-ups.

How do I take care of myself?

Learning to live with subacute cutaneous lupus can be challenging. Your life has changed, but there are ways to help you live with the disease and put you in control.

• Understand the condition: Read everything you can about the disease from reputable sources so you have a better understanding of what’s going on in your body.
• Find a trusted healthcare provider: You’ll have many doctor’s appointments in your future. Make sure you’re working with someone who understands the condition and can help you best manage it.
• Look for a support network: Sharing your experience and listening to others in the same camp as you can help you feel emotionally supported and less alone.
• Take care of yourself: Eat healthy, get physically active, prioritize sleep and manage your stress. While you can’t always control the disease, taking care of yourself can put you in charge of your life.

When should I see my healthcare provider?

See your healthcare provider if you develop any symptoms of subacute cutaneous lupus. They may refer you to a dermatologist to make a diagnosis. It’s important to find a provider that you trust. Someone who will take the time to listen to your concerns and work with you to find medications that will help relieve your symptoms. You may need to see them regularly as symptoms can change, and you also may need adjustments to your medications over your lifetime.

What questions should I ask my healthcare provider?

You may want to ask your provider:

• What’s 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?