Basic treatment
Cutaneous lupus erythematosus is a group of autoimmune diseases with a chronic course and recurrent attacks. Therefore, we should pay attention to patient education, including proper understanding of the disease, preparation for long-term treatment, and active cooperation with doctors. Patients should avoid adverse stimuli and follow up regularly; pay attention to protection from cold and light, such as wearing sunglasses, using sunscreen and sun-protective clothing, etc. Treatment is generally based on a “stepwise treatment” approach, which means that the appropriate treatment method is chosen according to the condition.
Topical treatment
Local and intra-dermal glucocorticoid application is one of the most widely used treatments. Topical glucocorticosteroids are selected according to the site and type of lesion. Weak or moderately potent preparations are used for thin skin, while strong or super-potent preparations are used for hypertrophic and verrucous lesions or local injections of glucocorticoids within the lesions.
Calcium phosphatase inhibitors such as tacrolimus ointment and pimecrolimus cream are effective for SCLE and ACLE, but slightly less effective for DLE.
Retinoic acid preparations such as tazarotene gel and retinoic acid cream can be used for DLE with marked keratinization.
Antimalarial drugs
Antimalarials are the first line of systemic therapy, especially for DLE, swelling lupus erythematosus and SCLE, with an efficiency of more than 80%. The main ones are hydroxychloroquine, 200-400mg/d orally for adults, up to 6.5mg/(kg?d) for those who are not overweight; chloroquine, 125-250mg/d for adults, up to 3.5-4mg/(kg?d); quinacrine (miparin) 100-200mg/d, up to 2.5mg/(kg?d); hydroxychloroquine or chloroquine can be combined with quinacrine Combined application. Ophthalmologic examination should be performed every 3 to 6 months during the drug administration period, and attention should be paid to ocular adverse reactions.
Glucocorticoids
Glucocorticosteroid therapy is required for DDLE, SCLE and some NLE, usually at low to moderate doses, such as prednisone 0.5 mg/(kg?d), and slowly decreasing after the disease is controlled.
Immunosuppressants
These drugs are mainly used in patients who have not had good results with conventional drugs. The following immunosuppressive drugs can be used: azathioprine [1-2 mg/(kg?d)], methotrexate (7.5-25 mg/week), morte-macrolide [35 mg/(kg?d)], cyclosporine (2.5-5 mg/d), etc. During the course of use, attention should be paid to the observation of adverse effects and timely adjustment of medication.
Other systemic treatment
Thalidomide for relapsed or refractory cutaneous lupus erythematosus, 100-200mg/d for adults, orally, maintenance available 25-50mg/d, contraindicated in women planning pregnancy or during pregnancy.
Aminophenone is mainly used for the treatment of SLE maculopapular lesions, but also for DLE and SCLE where conventional treatment is not effective. 100-200 mg/d orally for adults.
Plant-derived drugs are generally a mixture of certain types of drugs, not a single component, such as Leigongjiang polysaccharide, total glucoside of peony, etc. These drugs have certain immunosuppressive and/or immunomodulatory effects. Dosage: Radix Polygoni Multi-glucoside 30-60mg/d; Baishao Total Glucoside 0.6g, 3 times daily; Torch Flower Root Tablets, 2 tablets, 3 times daily; Kunming Shanghang 2 tablets, 3 times daily orally. Radix Polygoni, Torch Flower Root Tablets, and Kunming Mountain Begonia have certain adverse effects on the gonads and should be used with caution in female patients of childbearing age.
Retinoic acid is mainly used for the treatment of chronic and subacute cutaneous lupus erythematosus, especially for warty lupus with positive efficacy. For example, Aveline 0.51mg/(kg/d) and isotretinoin 1mg/(kg/d), divided into 2 oral doses. Contraindicated in women planning pregnancy or during pregnancy.
Biological agents such as intravenous human immunoglobulin, rituximab, belimumab, abciximab, anti-IL-6 monoclonal antibody and anti-IL-10 monoclonal antibody may be used in patients with severe disease such as ACLE.
Other gold agents such as kinolfine, 6-9 mg/d for adults, and salazosulfapyridine 0.75-1.5 g/d. Chlorpheniramine, 100 mg/d for adults.
Follow-up
Patients with CLE should be routinely followed up on a regular basis. Routine laboratory tests (e.g., routine blood and urine) should be performed at the time of follow-up, and liver and renal function should be reviewed at 3 to 6 months, and immune function at 6 to 12 months. Evaluate whether the disease is stable and whether it has developed into SLE. pay attention to the adverse effects of drugs. Those taking glucocorticoids should have regular blood pressure and blood glucose checks, and those taking hydroxychloroquine or chloroquine should have an eye examination every 3 to 6 months.
Prognosis
Most of the lesions of CLE can subside after treatment, but some CCLE may leave atrophic scarring and pigmentation or loss, and some patients with DLE lesions may persist for a long time. The prognosis of patients with CCLE and SCLE is good because they do not have significant organ involvement, while the prognosis of patients with ACLE depends on the degree of significant organ involvement.