Treatment

Initial treatment comprises the avoidance of direct sunlight. The use of a high factor sun - screening agent (at least factor 15) and clothes (such as baseball caps without vent holes and wide-brimmed hats) for protection against sunlight are useful measures (1)

Medical options:

• topical corticosteroids such as betnovate are often effective, and are one of the few instances in which such agents may be used on the face. These agents prevent scarring and deformity of the face. Side effects of steroids include steroid withdrawal syndrome, perioral dermatitis, steroid acne, and rosacea (1)
• in some patients with widespread disease, systemic agents such as chloroquine and mepacrine may be required
  • mepacrine is less toxic but may cause a yellow discoloration of the skin
  • chloroquine - is considered to be the gold standard treatment method in patients with DLE. Due to the ocular side effects of chloroquine, hydroxychloroquine is the commonly used agent. It may cause permanent retinal damage and ophthalmic assessment is required at the beginning of treatment and again after 4-6 months during treatment (1)
• additional treatment options include:
  • azathioprine
  • retinoids
  • dapsone
  • rhalidomide
  • racrolimus -according to some clinical trials application of 0.01% tacrolimus twice daily has been shown to be helpful in managing patients (1)
  • methotrexate - shown to be effective for recalcitrant disease (2)
• surgical options:
  • Surgery can be used:
    • to remove scarred lesions
    • for lesions with prominent teleangiectasis - laser therapy (1)
• patient education: Plays an important part in the management of DLE. Patients should be advised on how to avoid sun light and on the use of proper sunscreen. Smoking should be avoided (1)

Reference:

• 1. Nayla Idriss et al. Dark brown scaly plaques on face and ears. JFP 2006; 55(6)
• 2. Langan SM, Groves RW, West J. The relationship between neurological disease and bullous pemphigoid: A population-based case-control study. J Invest Dermatol. 2011;131:631-6.