In addition to sun avoidance, your dermatologist may recommend medication to help manage the symptoms of cutaneous lupus. This condition doesn’t affect everyone the same way, so your doctor determines the best medication or medications for you based on the severity of your symptoms, the location of the lesions, and whether you have also been diagnosed with systemic lupus erythematosus, an autoimmune disease that affects people with some types of cutaneous lupus.
If you’ve been diagnosed with systemic lupus, your dermatologist works closely with your rheumatologist, a doctor who specializes in conditions that cause painful swelling in joints and muscles, to help relieve the symptoms of both conditions.
Cutaneous lupus symptoms may change over time, so your dermatologist monitors your skin during regular follow-up appointments. He or she may adjust the type or dose of medication to ensure that treatment remains effective while prescribing the least amount of medication necessary.
Corticosteroid medications have anti-inflammatory properties that can reduce inflammation and relieve redness, burning, itching, and swelling. Corticosteroids also help shrink and flatten raised lesions.
Topical corticosteroid treatment is often part of a long-term treatment plan. Your dermatologist may prescribe medication in cream or gel form that you apply daily. As symptoms recede, you may be able to reduce the applications to two or three times a week and still control symptoms.
In addition to topical medication, your dermatologist may inject steroid medication into a large lesion to deliver medication to deeper layers of skin. Injections are administered in the doctor’s office and take a few minutes.
The doctor may inject medication into more than one area of a large lesion, or he or she may treat more than one lesion during the same appointment. Topical and injected corticosteroids take effect in about a week, although injected steroids often work faster.
Occasionally, your dermatologist may prescribe a corticosteroid that is taken daily by mouth. This medication can be very effective, but it may cause side effects. These may include stomach upset; high blood pressure; and eye problems, including glaucoma and cataracts.
For this reason, doctors prescribe an oral corticosteroid only when necessary. They may be used to treat sudden flares, or if other forms of corticosteroids don’t relieve your symptoms. Or, the doctor may give you an oral corticosteroid if he or she is also treating you with an antimalarial or immunosuppressant medication, which may not take effect for weeks or months.
Antimalarial medications have immunomodulatory properties, which means they help alter an overactive immune system response and can reduce the number and size of the lesions associated with cutaneous lupus. These medications may also relieve burning, itching, swelling, and redness. Usually they are taken daily by mouth.
With regular use, antimalarial medications may control symptoms and prevent future breakouts. Some people take them for the rest of their lives.
Often, antimalarial medications don’t take effect for six weeks or longer. During this time, a dermatologist may suggest using corticosteroid medications. After the antimalarial medication kicks in, your dermatologist may recommend taking a smaller dose of corticosteroids or stopping steroid treatment altogether.
Side effects of antimalarial medications include upset stomach, dry skin, and damage to the retina, a light-sensitive membrane located in the back of the eye. People who take these medications often see ophthalmologists for regular eye exams.
Smoking cigarettes reduces the effectiveness of these medications. Our dermatologists encourage people who are being treated for cutaneous lupus to stop smoking. NYU Langone’s Tobacco Cessation Programs can help you to quit.
If the skin rash and sores associated with cutaneous lupus don’t improve after taking steroid or antimalarial medications, your dermatologist may recommend an immunosuppressant medication. This medication suppresses the body’s overactive immune system, reducing redness, swelling, burning, and itchiness.
It may take many weeks to months for these medications to take effect, so your doctor may prescribe a corticosteroid medication to relieve symptoms in the meantime. After immunosuppressant medications start to control your symptoms, the dermatologist may reduce or stop steroid therapy. Immunosuppressant medications are often used for long-term management of your symptoms.
Immunosuppressant medications may be given as tablets or injections, or they may be administered through a vein with intravenous (IV) infusion at an NYU Langone infusion center in Manhattan or Brooklyn. During an infusion, a nurse inserts a slim, flexible tube called a catheter into a vein in the arm. The medication is injected into the catheter, which delivers it into your body. Infusions may last for a few hours.
Your doctor determines the right treatment schedule for you depending on the diagnosis and the medication prescribed.