Subacute cutaneous lupus erythematosus (SCLE) is a subtype of cutaneous lupus erythematosus, characterized by distinct skin lesions and often associated with systemic lupus erythematosus (SLE). Below is a concise overview based on current medical understanding:

Key Features

• Skin Lesions: SCLE typically presents with red, scaly, non-scarring skin lesions, often in sun-exposed areas like the upper back, chest, shoulders, and arms. Two main patterns:
• Annular: Ring-shaped, red lesions with central clearing.
• Papulosquamous: Scaly, psoriasis-like plaques.
• Photosensitivity: Lesions are often triggered or worsened by sunlight (UV exposure).
• Systemic Involvement: About 50% of SCLE patients have mild systemic lupus symptoms (e.g., joint pain, fatigue). Fewer develop severe organ involvement compared to SLE.
• Autoantibodies: Commonly associated with anti-Ro/SSA and anti-La/SSB antibodies. ANA (antinuclear antibody) is positive in most cases.

Causes and Risk Factors

• Autoimmune: SCLE is an autoimmune condition where the immune system attacks skin and sometimes other tissues.
• Triggers: Sun exposure, medications (e.g., hydrochlorothiazide, terbinafine, or proton pump inhibitors), and smoking are known triggers.
• Genetics: Associated with certain HLA genotypes (e.g., HLA-DR3).
• Demographics: More common in women, typically in their 30s–50s, and more frequent in Caucasians.

Diagnosis

• Clinical Evaluation: Based on lesion appearance, location, and photosensitivity.
• Lab Tests: Blood tests for anti-Ro/SSA, anti-La/SSB, ANA, and sometimes complement levels (C3, C4).
• Skin Biopsy: Shows interface dermatitis with lymphocytic infiltration, confirming diagnosis.
• Differential Diagnosis: Psoriasis, dermatomyositis, tinea corporis, or drug-induced lupus.

Treatment

• Sun Protection: Broad-spectrum sunscreen (SPF 50+), protective clothing, and avoiding peak sun hours.
• Topical Therapies:
• Corticosteroids (e.g., clobetasol) for active lesions.
• Calcineurin inhibitors (e.g., tacrolimus) for sensitive areas.
• Systemic Therapies:
• Antimalarials (e.g., hydroxychloroquine) are first-line, effective in most cases.
• Oral corticosteroids (short-term) for flares.
• Immunosuppressants (e.g., methotrexate, mycophenolate) for refractory cases.
• Lifestyle: Smoking cessation and avoiding trigger medications.

Prognosis

• SCLE is generally manageable with treatment, but chronic or recurrent lesions are common.
• Most patients have a good prognosis, with low risk of severe systemic complications compared to SLE.
• Regular monitoring is needed for systemic involvement or drug side effects (e.g., hydroxychloroquine retinal toxicity).

Notes

• If you have specific symptoms, a healthcare provider can tailor diagnosis and treatment.
• For more details, consult resources like UpToDate, Medscape, or dermatology/rheumatology specialists.

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