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Therapeutic Approach

Cutaneous lupus erythematosus (CLE) is an autoimmune condition of the skin and mucosal surfaces that can occur with or without concomitant systemic lupus erythematosus. CLE is divided into three major subtypes—acute CLE, subacute CLE, and chronic CLE—which present with distinct clinical findings but often have shared histologic features, such as interface dermatitis. The goal in treating CLE is to reduce the level of active inflammation to prevent resulting damage to the skin, such as dyspigmentation and scarring.

In the authors’ experience, first-line therapy for CLE should include topical corticosteroids and antimalarials. Topical calcineurin inhibitors are often used for long-term use or sensitive skin areas. In refractory cases, methotrexate or mycophenolate mofetil are often started though they may not be tolerated. Evidence levels for additional therapeutic options are outlined below. See Table 46-1.

Table 46-1Lupus Erythematosus Treatment Table

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