What is it about ?
the systemic or systemic lupus erythematosus (SLE) is an autoimmune inflammatory condition. The adjective “autoimmune” means that the body’s immune system makes antibodies against the body’s own cells. The body will then, so to speak, attack itself. In doing so, inflammatory reactions leading to damage can occur in all organs. the lupus can affect the whole body: skin, mucous membranes, muscles, heart, blood vessels, kidneys, lungs, joints, nervous system, etc. Sometimes the damage is limited to a single organ or system.
It is called cutaneous lupus (discoid lupus erythematosus (SLE)) for lesions of the skin. In the case of SLE, it is mainly the skin that is affected. However, other signs may be present.
The term “discoid” means that disc-shaped lesions appear on the skin, the adjective “erythematous” means that the lesions are red. Skin lesions are also possible with other forms of lupus and skin lupus can turn with age into disseminated lupus.
It is not known what causes skin lupus. Hereditary factors could play a role.
What is its frequency?
Skin lupus usually develops between the ages of 20 and 45. It is more common in women than in men.
How to recognize it?
Skin lesions mainly occur on areas of the skin exposed to the sun: face, scalp, neck, chest, back of the hand and arms. Because these lesions are very sensitive to sunlight, they become worse when exposed to it. Flare-ups appear mainly in spring and summer.
The lesions are the size of a fingertip, they are reddish, rounded and covered with scales (skin dandruff). They heal in their center but leave a scar. Usually, skin lesions do not cause complaints, but sometimes they do. itching. In the event of damage to the scalp, a hair loss is possible. Rarely, sores can also appear on the mucous membranes of the mouth.
How is the diagnosis made?
The doctor will consider the diagnosis based on the nature of the skin lesions. Then he will always perform a biopsy : he takes a small piece of skin from the lesion to have it examined in the laboratory. He will also take a blood test to determine the amount of antibodies present and their type.
What can you do ?
Avoid exposure to sunlight by wearing suitable clothing that covers your arms and legs.
Always apply a sunscreen with a high index on the exposed skin.
What can the doctor do?
In mild cases, treatment will be limited to the administration of a moderately strong cortisone cream to be applied to the affected skin: once a day in the evening for 2-3 weeks, then twice a week for 1-2 month. In case of recurrence, the treatment can be repeated.
In more severe cases, the doctor will prescribe generalized treatment. We will start with hydroxychloroquine, a drug that also has an anti-inflammatory action. Usually 1 or 2 tablets of 200 mg per day are sufficient. Blood should be checked regularly because of the possible side effects. In the event of prolonged use of hydroxychloroquine and / or in high doses, an ophthalmologist must also carry out regular checks given the possible toxicity of the product for the retina.
If this treatment is not sufficient, treatment with cortisone may be considered. You start with a high dose, which is gradually reduced over a longer period. Another option are products that slow down the body’s defense mechanisms (immunosuppressive drugs), such as methotrexate or thalidomide. For these treatments and checks, it is advisable to be followed by a doctor specializing in the skin (dermatologist).
Want to know more?
- Corticosteroids for the skin (medium potency preparations) – CBIP – Belgian Center for Pharmacotherapeutic Information
- Hydroxychloroquine – CBIP – Belgian Center for Pharmacotherapeutic Information
- Methotrexate – CBIP – Belgian Center for Pharmacotherapeutic Information
- Thalidomide – CBIP – Belgian Center for Pharmacotherapeutic Information
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