Chronic Cutaneous Lupus Erythematosus Difficult Management

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Chronic Cutaneous Lupus Erythematosus Difficult Management

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Chronic Cutaneous Lupus Erythematosus Difficult Management

  1. 1. Chronic Cutaneous Lupus Erythematosus What would you propose as therapeutic option in this case?
  2. 2. Chronic cutaneous LE <ul><li>63-year-old women. </li></ul><ul><li>Diagnosed of Chronic Cutaneous Lupus Erythematosus in 2006. </li></ul>
  3. 3. Chronic cutaneous LE <ul><ul><li>Physical examination </li></ul></ul><ul><ul><li>Smooth, non scarring, pink to violaceous papules or plaques without evidence of surface change. </li></ul></ul><ul><ul><li>Loceted on the face and upper extremities. </li></ul></ul>
  4. 4. Chronic cutaneous LE <ul><li>Skin Biopsy revealed : </li></ul><ul><ul><li>A superficial and deep lymphocytic infiltration in a perivascular and periadnexal distribution . </li></ul></ul><ul><ul><li>D ermal interstitial mucin deposition and focal or absent dermoepidermal junction involvement. </li></ul></ul>
  5. 5. Chronic cutaneous LE <ul><li>Laboratory examinations: </li></ul><ul><ul><li>Antinuclear antibodies: 1/40. Homogeneous. </li></ul></ul><ul><ul><li>Anti SSA/RO: positive. </li></ul></ul>
  6. 6. Chronic cutaneous LE
  7. 7. Chronic cutaneous LE
  8. 8. Chronic cutaneous LE <ul><li>Treatment was prescribed without improvement in 2006: </li></ul><ul><li>Topical tacrolimus, pimecrolimus and corticosteroids. </li></ul><ul><li>Hydroxychloroquine at a dose of 400-600 mg/d for 6 months. </li></ul><ul><li>Prednisone at a dose of 0,5 mg/ kg/ d for 3 months. </li></ul>
  9. 9. Chronic cutaneous LE 2007
  10. 10. Chronic cutaneous LE 2007
  11. 11. Chronic cutaneous LE <ul><li>Treatment was prescribed without improvement in 2007 </li></ul><ul><li>Dapsone at a dose of 100 mg/d for 8 months. </li></ul>
  12. 12. Chronic cutaneous LE 2008
  13. 13. Chronic cutaneous LE <ul><li>Treatment was prescribed without improvement in 2008-2009. </li></ul><ul><li>Methotrexate at a dose of 15mg at week for 4 months. </li></ul>
  14. 14. Chronic cutaneous LE 2009
  15. 15. <ul><li>What would you propose as therapeutic option in this case? </li></ul>Chronic cutaneous LE F.Peral Rubio, M.D. Department of Dermatology Complejo Hospitalario Universitario, Badajoz, Spain.

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