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.
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
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