Cutaneous Lupus: Symptoms, Treatment, and When to Seek Help - Internal Medicine

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cutaneous lupus


Hello Doctor, I am currently in Germany.
I have a large area of redness and swelling near my knee on my thigh, resembling a bruise, and it is itchy.
Additionally, I have experienced hair loss and itching on my scalp in the past, but I'm not sure if it's related.
The doctors here conducted blood tests, which showed no abnormalities.
After performing a skin biopsy on my leg, the doctor diagnosed it as cutaneous lupus.
I have been on medication for several months, and the itching has slightly improved, but when the dosage of the steroid medication was reduced, the itching returned.
Could my symptoms be indicative of systemic lupus erythematosus? Should I consider returning to Taiwan for treatment?

Miss Zhang, 40~49 year old female. Ask Date: 2021/09/17

Dr. Gao Jiankai reply Internal Medicine


Hello, thank you for your message.
Cutaneous lupus may gradually develop into systemic manifestations, which is known as systemic lupus erythematosus (SLE).
Therefore, it is essential to have regular check-ups to determine whether the symptoms remain confined to the skin or if they have begun to affect the entire body, in order to decide whether to adjust the treatment plan.
I am not very familiar with the healthcare model in Germany.
However, you can start by discussing with your physician to understand their treatment plan, including how often follow-ups will occur, lifestyle adjustments, any other precautions to take, and the likelihood of future changes.
This will help you decide whether you can accept this treatment approach and if it meets your expectations.
Given the significance of returning to Taiwan, I recommend trying this approach first.
The Allergy, Immunology, and Rheumatology Department at Changhua Hospital cares about you.

Reply Date: 2021/09/17

More Info


Cutaneous lupus erythematosus (CLE) is a form of lupus that primarily affects the skin. It is important to understand that while CLE can be a localized skin condition, it may also be a precursor to systemic lupus erythematosus (SLE), which is a more severe form of lupus that can affect multiple organ systems. Your symptoms, including the large red, swollen area on your thigh and the history of hair loss and itching on your scalp, are indeed consistent with cutaneous lupus. The fact that a skin biopsy confirmed this diagnosis is significant.

The symptoms you describe—redness, swelling, and itching—are common in cutaneous lupus. The lesions can resemble bruises or rashes and may be itchy or painful. The hair loss you mentioned could be related to a condition known as discoid lupus erythematosus, which can cause scarring and hair loss in affected areas. It's also worth noting that the itching you experience may be exacerbated by the reduction of corticosteroid medication, as these medications help to control inflammation and symptoms.

In terms of treatment, it appears that you have been on corticosteroids, which are commonly prescribed to manage inflammation associated with lupus. However, the challenge with corticosteroids is that they can have side effects, and tapering them can lead to a resurgence of symptoms, as you've experienced. It's crucial to have a discussion with your healthcare provider about your treatment plan, especially regarding the management of your symptoms as you reduce your steroid dosage. They may consider alternative treatments, such as topical therapies, immunosuppressants, or antimalarial medications like hydroxychloroquine, which are often used in lupus management.

Regarding your question about whether to return to Taiwan for treatment, this decision should be based on several factors. First, consider the quality of care you are receiving in Germany. If you feel that your current healthcare providers are not adequately addressing your symptoms or if you have concerns about the treatment options available to you, it may be worth seeking a second opinion or exploring treatment options in Taiwan. However, returning to Taiwan for treatment should also consider the continuity of care and the potential need for follow-up appointments and monitoring.

In conclusion, your symptoms are indeed indicative of cutaneous lupus, and it is essential to maintain regular follow-ups with your healthcare provider to monitor the condition and adjust treatment as necessary. Discuss your concerns about symptom management and the possibility of returning to Taiwan with your doctor, as they can provide personalized advice based on your medical history and current condition. Remember, effective management of lupus often requires a multidisciplinary approach, including dermatologists, rheumatologists, and possibly other specialists, to ensure comprehensive care.

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