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  • Presentation

Cutaneous Lupus: Treatment Pearls for the General Dermatology Clinic

Description

The presentation discusses cutaneous lupus management, emphasizing that dermatologists play a vital role in treating this condition. It covers essential treatment modalities ranging from topical therapies to systemic options, pinpointing the importance of sun protection due to the disease's photosensitivity. The speaker highlights that patients often neglect sunblock, necessitating dermatologists' education on its proper use and application frequency. They stress the critical role of anti-malarials such as hydroxychloroquine in managing lupus, while also detailing the potential risks involved with treatments like glucocorticoids. A brief overview of advanced therapies such as DMARDs and other new medications indicates a shift towards more aggressive treatment for extensive or challenging cases. The talk addresses pitfalls and emphasizes comprehensive care, reminding practitioners that not every new skin issue in lupus patients is directly due to lupus itself, advocating for a holistic and careful approach. Through patient examples, the speaker demonstrates effective strategies and the evolving landscape of lupus treatment, underscoring the urgency for dermatologists to actively engage in managing both cutaneous and systemic manifestations of lupus.

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Conclusions

  • General dermatologists can play a key role in managing cutaneous lupus alongside rheumatologists.
  • Photoprotection is critical for all lupus patients and should be reinforced in consultations.
  • Sunscreen usage remains low among cutaneous lupus patients, with many not using it at all, but it has significant benefits in preventing disease activity.
  • Topical medications are essential and can reduce the need for systemic treatments, yet they are often overlooked once patients are on systemic therapy.
  • Hydroxychloroquine is a cornerstone treatment for lupus with a 50-70% good to excellent response rate, and adherence to treatment is vital for effectiveness.
  • Expectations should be managed as hydroxychloroquine and other DMARDs may take 3-6 months to show peak effects.
  • Quinacrine can be used in conjunction with hydroxychloroquine for patients who do not respond to monotherapy.
  • Systemic glucocorticoids should only be used short-term and tapered down to avoid complications.
  • For aggressive and destructive cases of cutaneous lupus, advancing therapy with DMARDs like methotrexate or mycophenolate may be necessary.
  • New therapies such as anifrolumab show promise in treating cutaneous lupus, with positive early indications for patient response.
  • Kuhn et al. JAAD. 2011;64(1):37.
  • Chang J, Werth V. Expert Rev Clin Immunol. 2016;12(10):1109.
  • Ruland et al. Arth Care Res. 2013;65(5):767.
  • Faurscho et al. Br J Derm. 2007;156:716.
  • Pothinamthong et al. J Med Assoc Thailand. 2012;95(7):933.
  • Kraak, vaketel, prakken et al. Dermatologica. 1965. 130:293-305.
  • Callen. Arch Dermatol. 1982. 118:412-16.
  • Werth VP. Best Pract Res Clin Rheuamatol. 2013;27(3):391.
  • Keyes E et al. J Am Acad Dermatol. 2022 Aug;87(2):447-448.
  • Mittal L, Werth V. JAAD. 2017;77(2):374-7.
  • Chang, Piette, Foering et al. Arch Dermatol. 2011;147(11):1261-7.
  • Frances et al. Arch Dermatol. 2012.148(4).
  • Chasset et al. JAAD. 2016.74(4).
  • Shaw et al. JAMA Dermatol. 2023 Mar 15:e230175.
  • Bouché N et al. JAAD Case Rep. 2023 Aug 4;39:93-95. doi: 10.1016/j.jdcr.2023.07.030.
  • Morand E et al. Arthritis Rheumatol. 2023 Feb;75(2):242-252.
  • Sherman MA et al. Arthritis Rheumatol. 2023 Jan;75(1):120.
  • Jallouli et al. JAMA Dermatol. 2013.149(8).
  • Wolverton. Comprehensive Dermatologic Drug Therapy. 2001. W.B. Saudners.