Treatment CLE

*Depends on subtype AND whether associated with SLE

  • Photoprotection
    Behavior, clothing, high-SPF sunscreens ± physical blocking agent (titanium dioxide or zinc oxide)
  • Smoking cessation
  • General recommendation
    Vitamin D supplementation
  • Topicals
    • Steroids
    • Intralesional injection triamcinolone acetonide
    • Topical calcineurin inhibitors
    • Retinoids (DLE)
    • Combination treatments

Systemic

  1. Antimalarials *gold standard*, monotherapy or combined:
    Hydroxychloroquine (HCQ) (up to 5mg/kg/day)
    ± Quinacrine (100mg/day)
    OR Chloroquine (CQ) (up to 2.3mg/kg/day)
    ± Quinacrine (100mg/day)
  2. For antimalarial resistant CLE:
    • Methotrexate
    • Thalidomide
    • Lenalidomide
    • Mycophenolate mofetil
    • Azathioprine
    • leflunomide
    • Acitretin, isotretinoin
    • IVIG
    • Sulfasalazine, clofazimine
    • Systemic corticosteroids
    • Systemic steroids for severe CLE alone
    • Immune response modifiers (refractory disease): Rituximab, belimumab, tocilizumab (anti-IL6 antibodies), anifrolumab (anti-interferon-αR), ustekinumab, or janus kinase (JAK) inhibitors
    • Dapsone → bullous SLE