Treatment of tumid lupus erythematosus

SPF: sun protection factor.
* Photoprotection is a critical component of the treatment of tumid lupus erythematosus. Aggressive photoprotection generally consists of daily application of a broad-spectrum sunscreen (SPF 30 or higher), avoidance of peak sun hours, and use of sun-protective clothing.
¶ Tumid lupus erythematosus is a benign, asymptomatic condition that may spontaneously resolve over time. However, many patients desire treatment because the disease can be disfiguring and the course is unpredictable.
Δ Limited disease is generally defined as one to several small plaques involving a relatively small proportion of the total body surface area, typically limited to 1 or 2 body sites.
◊ Topical corticosteroid therapy is usually applied twice daily. Nonfacial involvement is typically treated with a moderate or high-potency (group 1 to 4) topical corticosteroid. Facial involvement is usually treated with lower-mid or low-potency (group 5 of 6) topical corticosteroids; however, to accelerate improvement of facial lesions, a high-potency (group 1 to 3) corticosteroid can be used for a shorter consecutive duration (eg, 4 consecutive days).
§ Intralesional corticosteroid therapy may be particularly useful for thick plaques with insufficient responses to topical therapy but are a less favorable option for thin plaques, large plaques, or areas not amenable to injection. Refer to UpToDate topics on tumid lupus erythematosus for suggested regimens. Significant improvement is expected within 3 injection sessions. Treatment should be discontinued if there is not significant improvement.
¥ Delayed recurrence is loosely defined as the return of skin disease at least several weeks after achievement of remission. Rapid recurrence occurs more quickly.
‡ Chloroquine is an alternative to hydroxychloroquine. Hydroxychloroquine is usually preferred because of a more favorable side effect profile. Local therapies utilized for limited disease (eg, topical corticosteroids) can be used as adjunctive therapy.
† Options for maintenance therapy include intermittent use of topical corticosteroids or topical calcineurin inhibitors.
** Proceeding directly to the addition of methotrexate or mycophenolate mofetil is an alternative. We typically reserve this for patients with severe disease or who exhibit poor tolerance to antimalarial drugs.
¶¶ Most patients with tumid lupus erythematosus respond well to local therapies or antimalarial drugs. Risks of proceeding to other therapies should be carefully reviewed in the context of disease severity. Aggressive therapy may not be warranted in some individuals with mild disease. Refer to UpToDate topics on tumid lupus erythematosus for details.
ΔΔ Antimalarial drugs are usually continued provided combination therapy is well tolerated.