Local therapy for cutaneous and systemic lupus erythematosus: practical and theoretical considerations

Local therapeutic measures should be maximized in the management of lupus e rythematosus (LE), particularly for patients with forms of LE-specific skin disease such as SCLE and CCLE. Local therapy consists of sun protection an d locally-applied pharmacologic agents, eg topical/intralesional corticoste roids. Patients should be advised to avoid direct sun exposure, wear lightw eight tightly woven clothing and broad-brimmed hats, and use broad-spectrum , water-resistant sunscreens. There are several modalities that enhance per meability of local therapeutics through the stratum corneum that could be a pplied to topical therapy of cutaneous LE, eg polar solvent, liposomal enca psulation, ethosomal system, iontophoresis, electroporation and sonophoresi s. As novel and more effective modalities to deliver pharmacologic agents a cross the stratum corneum become available, therapeutics that have been exp erimental and untested thus far may become part of the local armamentarium in the near future. In addition, physical/contact therapy as well as dermat osurgical methods can be invaluable in enhancing self-image and quality of life of patients with disfiguring cutaneous LE lesions.