Cutaneous lupus erythematosus (CLE) is an autoimmune disease that affects the skin, causing rashes or sores, usually after sunlight exposure. Treatment options include topical steroids, medications, and preventive measures such as avoiding direct sunlight.

CLE is a form of systemic lupus erythematosus (SLE). SLE is a chronic, or long-term, autoimmune condition where the immune system attacks tissues and organs within the body, causing inflammation across multiple organ systems, including:

  • skin
  • joints
  • kidneys
  • blood cells
  • brain
  • heart
  • lungs

CLE is a form of lupus that only affects the skin, which has different subtypes depending on the symptoms and presentation.

It doesn’t cause other symptoms of lupus, but people with CLE may go on to develop symptoms of SLE. People with SLE may first experience skin issues and then develop other symptoms or have other organ systems affected.

Of people with SLE, 75% will develop problems with their skin, while 25% of people with SLE initially experience skin issues as their first symptom prior to diagnosis.

People with CLE tend to be females between the ages of 20 and 50, and this condition is also more common in Black people or people of African descent.

Read on to find out more about diagnosis, symptoms, and possible treatment options for CLE.

There are three different types of CLE based on symptoms and presentation. These types include:

  • Acute cutaneous lupus (ACLE): ACLE rashes usually happen over a shorter period of time, tend to come and go quickly, and don’t cause permanent scarring. Lots of people who have ACLE typically also live with the form of lupus, SLE, that affects other organs in the body, and not just the skin. The ACLE rashes can be localized, which means someone with ACLE would develop a rash over both of their cheeks and the bridge of their nose called “the butterfly rash” or “malar rash.” This rash is usually red, pink, but can also appear dark purple or dark brown on darker skin, and raised, causing swelling and sometimes itchiness. These rashes can also be generalized, where raised rashes tend to appear all over the body, rather than on the face. These generalized rashes tend to occur in people with SLE.
  • Subacute cutaneous lupus (SCLE): SCLE commonly causes ring-shaped sores or patches on the body. These can be scaly, and their edges are usually very distinct. They don’t typically occur on the face or scalp and don’t cause skin scarring, like DLE rashes, but may still cause skin discoloration. Some cases of SCLE can be caused or aggravated by the use of certain medications, like proton pump inhibitors and calcium channel blockers. This can even occur months or years after using these drugs.
  • Chronic cutaneous lupus (CCLE): This type of CLE causes permanent scarring from skin lesions. These skin lesions tend to be long term. The most common subtype of chronic cutaneous lupus is called discoid lupus erythematosus (DLE). DLE typically causes disc-shaped rashes on the face, scalp, and ears, but they can appear on other parts of the body as well. These rashes can be persistent and scaly, often red, purple, or brown, and slightly raised above the skin surface. These rashes can cause scarring and skin discoloration, or hair loss on the scalp, where specific areas have been affected by the rash. In rare cases, cancer can develop in DLE sores that have been present for a long time. Other types of CCLE include:
    • lupus profundus
    • chilblain lupus erythematosus
    • lupus timidus

CLE manifests differently in some people. Symptoms may come and go, accompanied by periods of flare-ups and periods of remission. Symptoms of CLE can be different for everyone depending on the specific subtype they live with, but common symptoms include:

  • red, purple, or dark brown skin rashes on the face, neck, ears, scalp, or other parts of the body
  • rashes with ring-like patterns
  • a swollen rash that occurs across the cheeks and bridge of the nose, which can be red, purple, or dark brown
  • skin discoloration, which involves patches of darker and lighter skin, usually as a result of skin scarring
  • itching
  • skin irritation
  • swelling
  • hair loss due to scarring on the scalp
  • photosensitivity
  • mouth sores
  • swollen skin or discoloration around the nails, or nails that crack and fall off
  • dark or blue-black nails on darker skin tones
  • chapped lips
  • blister-like rash
  • livedo reticularis, a lacy pattern that appears on the skin
  • depressions in the skin
  • hives
  • palms that turn red
  • hard lumps under the skin
  • weak blood flow in the fingers and toes when exposed to cold (Raynaud’s phenomenon)

The cause of CLE is unknown, but multiple risk factors can make someone more likely to develop the condition. Having any or all of these risk factors does not mean someone will develop lupus.

These specific risk factors are more common in people who have developed the condition. Some of these include:

  • certain genes that once activated make it more likely to develop the condition
  • a family history of lupus, especially parents or siblings
  • female sex
  • being Black or of African descent
  • environmental factors including
    • use of certain medications
    • exposure to sunlight
    • smoking
    • viral infections
    • prolonged stress

To diagnose CLE, your doctor or dermatologist may ask questions about your symptoms and have an in-depth conversation about your medical history. They will typically perform a physical examination of your skin, scalp, and nails for potential rashes and sores.

They’ll check or ask whether you have sores in your mouth or inside your nose, and inquire about any medications you’ve been taking. They might also ask if you’ve had recurrent skin issues or other autoimmune diseases.

They may also order some tests, including:

  • blood tests, to check for specific proteins in your blood
  • skin biopsy, to analyze a small sample of your skin

Diagnosing CLE can take a while, as many of the symptoms can overlap with other skin conditions, so it’s important to work together with a specialist who can help.

CLE is not currently curable, so treatment options revolve around easing symptoms and improving your quality of life. This can include:

  • reducing rashes and sores
  • relieving symptoms like itchiness and pain
  • diminishing flare-ups
  • preventing or treating skin scarring
  • stopping irreversible hair loss

Some treatment options for CLE include medications and topical creams such as:

To help treat scarring or hyperpigmentation caused by certain types of CLE, your doctor or dermatologist may recommend laser therapy.

Healthcare professionals also recommend certain preventive measures such as:

  • avoiding exposure to UV light
  • quitting smoking (if applicable)
  • reducing stress

CLE is not curable, but treatment options are available to ease symptoms like swelling and pain and improve the appearance of rashes and sores. Doctors recommend certain preventive measures and lifestyle modifications to reduce the risk of flare-ups.

This can involve reducing sun exposure or using sun protection measures, such as broad-spectrum sun lotion or a wide-brimmed hat, to avoid triggering symptoms.

CLE is a form of lupus that affects the skin. Some people may initially develop symptoms of CLE but will later experience other symptoms that affect multiple organs, such as the kidneys, heart, or lungs.

Symptoms may come and go, with periods of remission when you might not experience any symptoms, and flare-ups. CLE is not curable, but topical creams and medications can help relieve symptoms during a flare-up.

Reach out to your doctor if you’re experiencing any skin issues.