Case 1. A 75-year-old woman with erythematous-scaling plaque of the nose

A 75-year-old woman presented with a unique erythematous-scaling plaque of the nose. A skin biopsy showed an interface dermatitis, consistent with the diagnosis of localised cutaneous lupus. Based on clinical and laboratory findings, systemic lupus was revealed. According to guidelines, hydroxychloroquine 400 mg/day was introduced in association with topical treatment with resolution of skin lesions in a few weeks with no relapses in the follow-up period.

Case 2. Recalcitrant skin lesion in a 62-year-old woman with systemic lupus erythematosus

A 62-year-old-woman with a 16 year-history of systemic lupus, presented with erythematous-infiltrated and partially hyperkeratotic skin lesions on the trunk, arms and face. Lesions were extremely itchy. A skin biopsy confirmed cutaneous lupus. All systemic treatments, including hydroxychloroquine, quinacrine and belimumab failed. The patient was re-evaluated to exclude the presence of external factors associated to the exacerbation of the disease. Finally, methotrexate 15 mg weekly improved the lesions.

Discussion Points: We discuss two cases focusing on the importance of correct diagnosis and treatment of specific lupus skin lesions. Antimalarials remain the first-line therapeutic option, but choice of other drugs should be taken into consideration in cases of refractory forms of cutaneous lupus.

Learning Objectives

• Discuss the therapeutic guidelines of lupus erythematosus

• Discuss the therapeutic options in recalcitrant cutaneous lupus erythematosus

• Explain the role of itching in cutaneous lupus erythematosus

• Describe factors predicting exacerbation