​Cutaneous Lupus Erythematosus

Cutaneous lupus erythematosus (CLE) is a chronic autoimmune disorder which affects millions of people worldwide, and is a skin-related form of lupus erythematosus (LE).
 
Lupus is a disorder, where your body’s immune system (the body’s natural defence system) begins to attack its own tissues and organs, thus causing much damage to your body. Some consider lupus along a spectrum, with chronic cutaneous lupus erythematosus (CCLE) on one end, and systemic lupus (which affects your system and organs) on the other.

CLE often manifests at some point if you suffer from systemic lupus erythematosus (SLE), but may also occur without it. Thus, CLE and the resultant skin-related symptoms can be an early indicator of SLE.

Cutaneous lupus erythematosus is classified into three main subtypes:

  • Acute cutaneous lupus – The most common indicator of this is a malar rash, which is a rash triggered by sunlight. This may somewhat resembles the wings of a butterfly and can spread across both your cheeks, the bridge of your nose, or your ears.

  • Subacute cutaneous lupus erythematosus – This is usually characterized by either coin-shaped red patches on your skin which have a scaly border and a lighter centre, or by red bumps that are scaly which appear in sun-exposed areas.

  • Chronic cutaneous lupus erythematosus – The most common form is the classic discoid lupus erythematosus, which is called so because of its coin-like shape. These are usually red and scaly plaques which once resolved can leave behind either light or dark pigmentation marks. These can also cause scarring and atrophy (the thinning of your skin).   

The majority of the people diagnosed with Lupus are women, most often between the ages of twenty and fifty, however children, elderly, and males may also be affected. Patients with CLE exhibit obvious skin lesions frequently in areas that are exposed to the sun. Thus, a relapse of this chronic disease is often induced or worsened by UV light.

If you or someone close has been diagnosed with lupus, or any other autoimmune disease, you can be confident that you will receive quality treatment and advice from the T​eeth and Skin services​ at The Aga Khan University and Hospital.  There are many different forms of treatment for the various forms of CLE, depending on your diagnosis. Therefore, it is essential to receive an accurate diagnosis to determine the extent of skin involvement against the systemic involvement (as they may not always directly correlate with each other), and it is important to have regular consultations with your doctor throughout the course of your treatment.

 

Cutaneous lupus erythematosus (CLE) is characterized by periodic episodes of inflammation, meaning that the symptoms may go away for a time (remission) and then may reappear (relapse).  Some common skin-related symptoms may include rashes and flaky red spots which may tend to scar.

You may experience other signs of skin abnormalities that have not been mentioned above. Therefore it is important to notify your doctor of any skin abnormalities so that he or she may diagnose and treat your particular symptoms before they progress to a more serious state.  ​
You should visit your doctor and discuss your concerns if you notice any of the symptoms of cutaneous lupus, such as an unexplained rash or increased photosensitivity.

If you have been diagnosed with lupus, you should contact your doctor immediately if you experience any adverse symptoms, such as shortness of breath, blood in your urine or numbness or tingling in your hands or feet.

You should visit the emergency room immediately if you are experiencing any of the symptoms of a heart attack, such as chest pain or pressure, excessive sweating or shortness of breath.

You should also rush to the emergency room if you experience any of the symptoms of a stroke, such as sudden numbness, tingling or weakness felt on one side or part of your body (paralysis), a seizure, or sudden nausea or vomiting.​
Your time with your doctor may be limited, so make sure to prepare for your visit beforehand. H​ere ​(hyperlink) are some tips to help get you started. ​​

The Aga Khan University and Hospital is the only internationally accredited hospital and Pakistan. Thus, if you are diagnosed with either lupus or another autoimmune disorder, you can be assured that you will receive quality healthcare at our facilities.

If you experience any symptoms of cutaneous lupus erythematosus, it is important you receive a thorough evaluation by a doctor or physician. He or she will ask you about your complete medical history and record, and then conduct a physical examination. Other tests could include:

  • A blood test – these may be administered during diagnosis and throughout treatment. It may be done to check for signs of anemia, or for a decrease in your white blood cells, or to test for certain antibodies such as ANA (anti-nuclear antibodies).

  • Urine test – to test your kidney function

  • X-rays – to examine your internal organs, bones and tissues.

  • Biopsies – to analyze individual skin lesions ​

With CLE, there may not appear to be any lab abnormalities, especially if you only experience lesions of the discoid subtype. However, your doctor may select one or a combination of these tests, or may conduct other tests in order to accurately diagnose CLE.​


There is currently no cure for CLE; however there are treatment options available and lifestyle changes that can help control the symptoms of the disease. The intention of treatment for CLE is to improve the appearance of your skin and to prevent the lesions from leaving behind scars. Due to the fact that CLE is a chronic disorder, it is possible that you may be administered systemic treatment (treatment that travels through your bloodstream to the cell throughout your body), and it is important to have regular consultations with your doctor. Treatment will be selected for you depending on a number of factors, such as your age, the severity of your ailment, your previous medical history, and your personal preference or aversion to certain treatments.
Treatment for CLE and measures for protections include:

  • Sunscreens – this is a vital factor for protection against UVA and UVB rays which can aggravate and provoke skin lesions.   

  • Protective clothes – wear clothes that cover your skin, sunglasses, hats and sunscreen can help prevent further damage if you are photosensitive.    

  • Topical medications

  • Systemic treatment – to treat acute CLE. This may include drugs such as prednisone or other immunosuppressive drugs (e.g. methotrexate or cyclosporine).

  • Oral antimalarial pills – usually prescribed to patients with widespread CLE lesions. These work due to their anti-inflammatory properties.   

Some of these may be accompanied by regular exams and routine blood tests to assess the effect of medication. It is crucial to note that some of these medications may have negative side effects, such as internal bleeding, indigestion and diarrhoea. Thus, medication should not be taken without the advice and instructions of your doctor, as these may not be suitable for your particular circumstance.​

The Aga Khan University Hospital offers various support services to help with managing or recovering from the disease or condition. These include but are not limited to nutrition, physiotherapy, rehabilitation, specialized clinics and some patient support groups. Your doctor or nurse will advise you accordingly.
 
The Aga Khan University Hospital offers financial assistance to those who are in need and fulfil the eligibility criteria. For further information, you can contact the Patient Welfare Department. You can find the contact number of the Patient Welfare Department in the ‘Important Numbers’ section on the website homepage.
 
The financial counselling staff is available during office hours, at the main PBSD (Patient Business Services Department), to answer your financial queries on treatments’ costs and authorize admissions on partial deposit as per hospital policies allow. The financial counsellor in the emergency room is open 24/7. You can find the contact number of the Patient Business Services in the ‘Important Numbers’ section on the website homepage.​
Your doctor and or nurse will give you specific instructions about the prescribed medication. Please ensure that you take or use the prescribed medicine as advised. It can be dangerous to your health if you self-prescribe. Please inform the doctor or nurse beforehand if you have experienced any adverse reactions to any medications in the past. If you experience any symptoms of drug poisoning, overdose or severe reaction please contact the Pharmacy Service at The Aga Khan University Hospital immediately. You can find the contact number of the Pharmacy Services in the ‘Important Numbers’ section on the website homepage.​
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The information provided on our website is for educational purposes and not intended to be a substitute for medical advice, diagnosis or treatment. You should always seek the advice of your doctor or other healthcare professional provider.