This handout is for cutaneous lupus erythematosus (acle / scle / discoid + variants). Your care team identified this based on: photodistributed erythematous eruption — malar/butterfly (acle), annular/papulosquamous (scle), or fixed scarring discoid plaques (dle) (lu et al cle guideline pmid 34364171; german s2k part 1 pmid 34390136).
Other reasons your team may use this plan: atrophic scarring / dyspigmented plaque with follicular plugging ± scalp scarring (cicatricial) alopecia → discoid le — irreversible damage, early aggressive rx (german s2k part 2 pmid 34338428); uv-provoked or photoaggravated rash (sun-exposure/seasonal pattern) — the cle photosensitive entry (german s2k part 1 pmid 34390136); new drug (ppi, thiazide/ace-i/ccb, terbinafine, anti-tnf, taxane) followed by annular photodistributed eruption → drug-induced scle (he & sawalha pmid 29870500).
Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.
| Medication | Starting dose | How | When | What it does |
|---|---|---|---|---|
| rigorous_broad_spectrum_photoprotection | — | — | — | German S2k Part 2 (PMID 34338428) — broad-spectrum high-SPF (≥50) UVA+UVB sunscreen + photoprotective clothing + behavioural sun avoidance; UV is the principal CLE trigger and photoprotection prevents lesion induction. |
| smoking_cessation | — | — | — | Ezra & Jorizzo (PMID 22582908) + Dutz & Werth (PMID 21918570) — smoking blunts antimalarial response in CLE; cessation is central to maximising hydroxychloroquine efficacy and long-term remission. |
| vitamin_d_repletion | — | — | — | German S2k Part 2 (PMID 34338428) — rigorous photoprotection predisposes to vitamin-D insufficiency; supplement to maintain adequacy. |
Plan: Cutaneous lupus erythematosus — photoprotection-first + stepwise ladder (Lu et al CLE guideline 2021; German S2k 2021)
Contact your care team if any of the following happen:
Call 911 or go to the nearest emergency room right away if you have:
Chronic-disease maintenance: lifelong rigorous photoprotection + smoking-cessation reinforcement (central to antimalarial response), HCQ annual ophthalmology, longitudinal SLE-progression surveillance (ACLE/SCLE highest — re-screen renal/heme/serology periodically), early treatment of any new DLE activity to prevent irreversible scarring/dyspigmentation/scarring alopecia, skin-of-colour dyspigmentation + QoL support, anti-Ro pregnancy counselling/planning, and step-down/step-up criteria. Dermatology continuity for any systemic agent; rheumatology co-management if systemic lupus.
Guideline: Lu et al, J Autoimmun 2021 (ADA/AADV/CSD evidence- and consensus-based guideline for the diagnosis, treatment and long-term management of cutaneous lupus erythematosus; PMID 34364171, DOI 10.1016/j.jaut.2021.102707) + Worm et al German S2k guideline Part 1 (PMID 34390136, DOI 10.1111/ddg.14492) and Part 2 (PMID 34338428, DOI 10.1111/ddg.14491) + Hannon et al Cochrane review of interventions for cutaneous disease in SLE (PMID 33687069, DOI 10.1002/14651858.CD007478.pub2)