Image Case Report: Refractory, Acute, Cutaneous Lupus

Figures 3 & 4 A maculopapular erythematous, violaceous, scaling rash is evident on the dorsal and palmar surfaces of both hands.

Refractory cutaneous lupus has limited effective treatment options.

Refractory cutaneous lupus has limited effective treatment options. Consensus on the best therapeutic approach after failure of second-line agents is limited by low levels of evidence. However, as rheuma­tology health professionals, we are challenged to find a way to improve quality of life and permit steroid-sparing for these patients. In an expert perspective published in Arthritis & Rheumatology in 2020, lenalidomide is recommended as a potential third-line agent for refractory cases.² Studies of several other therapies at varying stages of development are underway.

More Info: See discussion with a dermatologist on this case here.

Samantha C. Shapiro, MD, is an academic rheumatologist and an affiliate faculty member of the Dell Medical School at the University of Texas at Austin. She received her training in internal medicine and rheumatology at Johns Hopkins University, Baltimore. She is also a member of the ACR Insurance Subcommittee.

References

1. Chasset F, Bouaziz J-D, Costedoat-Chalumeau N, et al. Efficacy and comparison of antimalarials in cutaneous lupus erythematosus subtypes: A systematic review and meta-analysis. Br J Dermatol. 2017 Jul; 177(1):188–196.
2. Borucki R, Werth VP. Expert perspective: An evidence‐based approach to refractory cutaneous lupus erythematosus. Arthritis Rheumatol. 2020 Nov;72(11):1777–1785.