Lupus erythematosus: Causes, forms, therapy

Lupus erythematosus is an autoimmune disease. The immune system mistakenly regards the body’s own cell structures as foreign and attacks them. There are three main forms of lupus erythematosus depending on the organs affected. The disease occurs mainly in young adulthood. Women are much more likely to develop lupus erythematosus than men, preferably in younger adulthood.

, Lupus erythematosus: Causes, forms, therapy

Lupus erythematosus: Description

Lupus erythematosus is an autoimmune disease. In the process, defence cells of the immune system (antibodies) attack the body’s own cell components and cause inflammatory changes. The exact causes for this malfunctioning of the immune system are still unknown.

Lupus erythematosus usually proceeds in relapses. The inflammatory changes primarily affect the skin. However, there are also forms of progression in which other organs are also involved. On this basis, physicians essentially distinguish three main forms of the disease. In addition, there are some other, rarer forms of lupus, which are usually restricted to the skin, for example Lupus erythematodes tumidus.

Chronic discoid lupus erythematosus (CDLE)

This form of lupus disease usually only affects the skin and is therefore sometimes called “skin lupus”. Here, the flare-ups are accompanied by the formation of disc-shaped (“discoid”), reddish-scaly skin changes, which are mainly seen in sunlit areas of the body such as the face. Triggers for the relapses can be light, stress, small injuries or infections. Chronic discoid lupus erythematosus usually develops between the ages of 20 and 40.

Systemic lupus erythematosus (SLE)

In this variant of lupus, internal organs are also affected in addition to the skin. Read all about this in the article Systemic Lupus erythematosus.

Subacute Cutaneous Lupus Erythematosus (SCLE)

Subacute cutaneous lupus erythematosus occupies an intermediate position between the two forms of the disease mentioned above. The affected patients have very extensive skin changes on sunny parts of the body on the one hand and antibodies typical of the disease in the blood on the other. The acute phase of the disease is often accompanied by muscle and joint pain. In rare cases subacute cutaneous lupus erythematosus develops further into systemic lupus erythematosus.

Frequency of lupus erythematosus

Lupus erythematosus is common worldwide, but is a rare disease. In industrialized countries, approximately 12 to 50 out of every 100,000 people suffer from the autoimmune disease. It usually occurs between the ages of 15 and 25, with women being affected about ten times more often than men.

Lupus erythematosus: symptoms

Which signs and symptoms the autoimmune disease can cause, you can read in the article Lupus erythematosus – symptoms.

Lupus erythematosus: Causes and risk factors

The exact causes of lupus erythematosus are not yet fully understood. According to experts, a genetic predisposition is the basis for the immune system disorder on which the disease is based. Other factors also seem to play a role. In addition to environmental factors such as UV light, these are mainly hormonal influences, since lupus erythematosus occurs much more frequently in women and girls than in men and boys (the hormone balance is subject to greater fluctuations in the female sex than in the male sex).

Medication

Certain medications, such as drugs for high blood pressure and epilepsy, can cause a lupus-like syndrome called drug-induced lupus syndrome. After stopping the medication, the syndrome generally disappears again.

Lupus erythematosus: Examinations and diagnosis

At the beginning of the diagnosis of lupus erythematosus, the doctor will have a detailed discussion with the patient (in children with their parents) about the patient’s medical history (anamnesis). This is followed by a physical examination and further examinations.

Skin examination

Typical skin changes occur in the various forms of lupus. An examination by a dermatologist is therefore important for the diagnosis. He takes a tissue sample from the skin (skin biopsy) and examines it under the microscope.

Further investigations

Blood tests can also provide important information about the autoimmune disease. In systemic lupus erythematosus and in most cases of subacute chronic lupus erythematosus, specific antibodies can be detected in the blood.

In addition, any suspicion of lupus erythematosus requires clarification of whether internal organs are also affected by the disease. If so, this speaks for a systemic lupus erythematosus. You can read more about the extensive diagnostics of this form of lupus in the article Systemic lupus erythematosus.

Lupus erythematosus: Treatment

The treatment of lupus erythematosus includes consistent light protection measures. Patients should avoid direct sunlight and use sunscreens with a high protection factor against UV-A and UV-B radiation.

In addition, the inflammatory skin changes are specifically treated: Individual foci can be supplied locally with cortisone (e.g. as ointment). In exceptional cases, a drug is administered which not only has an anti-inflammatory effect but also influences the immune reactions (immunomodulating preparations).

If these measures do not help or the skin changes are very extensive, the use of a drug that was originally developed against malaria can be tried. It is the antimalarial agent with chloroquine or hydroxychloroquine. Pregnant and breastfeeding women should not take this product. This treatment with the antimalarial agent leads to success in 75 percent of all cases. In general, the therapy is well tolerated. However, regular examinations of the ocular fundus are recommended, because in rare cases the therapy can cause changes. Patients with lupus erythematosus should also have their laboratory values checked regularly.

In the case of very severe inflammatory skin changes, additional tablets or infusions with cortisone can help.

The treatment of systemic lupus erythematosus is more extensive because internal organs are affected in addition to the skin. You can read more about this in the article “Systemic Lupus erythematosus”.

Lupus erythematosus: Prevent

The chronic inflammatory autoimmune disease Lupus erythematosus cannot be prevented. However, one should avoid factors that can trigger the disease (with the appropriate genetic predisposition) or relapses. In addition to factors such as stress and infections, this includes above all intensive sun exposure. You should avoid these even if you are already ill, because lupus erythematosus makes the skin more sensitive to sunlight.

Lupus erythematosus: Course of disease and prognosis

The prognosis for chronic discoid lupus erythematosus is good because the disease is limited to the skin. Years to decades later, the disease can come to a standstill.

Subacute cutaneous lupus erythematosus also often has a good prognosis. However, in less than five percent of patients, the disease continues to develop into systemic lupus erythematosus. In this form of lupus, the course of the disease and prognosis depend on which organs are affected. If kidneys, heart and lungs are involved, the disease often takes a severe course and can even be fatal in individual cases.

This text complies with the requirements of medical literature, medical guidelines and current studies and has been reviewed by medical experts.

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Sandra Eades
Hello I am Sandra Eades, physician, researcher and author from Australia. I am working currently as researcher for a private institution. I have studied in Britain and Australia, where I currently reside. I write about research topics in the organization of the public health government agencies. For the iMS I write about general medical conditions. I also research scholar sources to provide information to writers of other articles. I also check the citations of scholar papers. Finally, I read other articles before they are published. I am also a mother of three children!