All forms of cutaneous lupus may manifest photosensitivity. Cases with acute SLE may present with the characteristic butterfly facial rash in addition to constitutional symptoms, whereas subacute cutaneous lupus occurs in about 10% of patients with lupus erythematosus. Common skin presentations include an annular scaly erythematous, psoriasiform rash involving light-exposed areas, which may present abruptly, extensor surfaces of arms, dorsa of hands, V of chest and upper back and face. Patients may also manifest a diffuse nonscarring alopecia. The treatment of choice is topical steroids in mild cases but systemic therapy with antimalarials, corticosteroids,
and immunosupressants is usually required. Chronic forms of discoid LE present with weeks-to-months history of erythematous papules and plaques with follicular plugging and atrophy, with subsequent scar formation. The rash tends to occur on habitually exposed areas of the face, scalp, external ears, and hands. Scalp involvement results in scarring alopecia and approximately 5% of these patients develop systemic disease. DLE can be controlled with supervised use of potent topical steroids and adequate sunscreens. When systemic therapy is required, antimalarials are effective.
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