Laser therapy for refractory discoid lupus erythematosus when everything else has failed.
Discoid lupus erythematosus (DLE) is restricted to the skin, mostly the face, often chronic and disfiguring. Standard medical therapies include topical corticosteroids and antimalarials. This is a retrospective long-term follow-up of refractory DLE treated with different lasers and intense pulsed light (IPL).
METHODS AND MATERIALS:
Sixteen patients with histologically confirmed DLE participated in this study. Two men and fourteen women, aged 28-69 years, mean age 54 years, were treated at the laser units of the Departments of Dermatology at the University Hospital of Örebro from 2001 and at Skåne University Hospital in Malmö, Sweden from 1999. Several therapies, including first- and second-line treatments and even cryotherapy, had been used without response. Many patients had marked scarring. Pulsed dye laser (PDL) and IPL were used with low fluencies.
Of 16 patients, 14 were improved regarding itching, erythema, scaling, scarring and pain. There was no scarring as a side effect of laser therapy or IPL. Two patients were not satisfied: one because of long healing time, and the other because of post inflammatory hyper pigmentation. Conclusion: IPL and PDL is a safe adjunctive therapy to conventional treatment of DLE. In the effort to prevent severe scarring and disfigurement it should be used as early as possible.
EMLA Laser Health J 2007;2:46-67
European Medical Laser Association (EMLA)
Successful treatment of discoid lupus erythematosus (DLE) with low-level laser therapy (LLLT): report of a case.
Kazemi N., Mokmeli L.
Laser clinic, Milad hospital, Tehran, Iran.
Lupus is a chronic autoimmune illness characterized by autoantibodies directed at nuclear antigens. Lupus may also appear as a skin disease only. Discoid lupus erythematous (DLE), the most common form of chronic Cutaneous lupus erythematous is characterized by persistent erythema, adherent scaling, follicular plugging and, in the later stages scaring and atrophy.
A 33 years-of-old female with 2 years history of skin lesions referred to us with acute flare of DLE since about 7 months as 4 lesions (3 with local alopecia, scaling and itching and one with atrophy). Studies for antinuclear antibodies and Anti Ro/SS-A antibody were negative. After 5 sessions of treatment with infrared (830 nm; 200 mW) and red light (630 nm; 20 mW) diode laser in addition to intravenous red light laser (655 nm; 2 mW) for 20 minutes and laser acupuncture with infrared diode laser (1 J/cm 2 ) for LI-11, LI-4, SP-6, PC-6, ST-36 and GB-34 points every other day, the beneficial effects started to appear, and after 9 sessions, local itching of the lesions discontinued. Through a total 27 sessions of treatment, the lesions improved completely with highly satisfactory results; and drug-therapy held to be continued. During 1 month, the patient was uneventful without any medication.
Low level laser therapy can be effective in treating such inflammatory lesions as cutaneous lesions of discoid lupus erythematosus. But, more studies are to be needed to more clarify the role of low level lasers in treating such lesions.
Rheum Dis Clin North Am. 2000 Feb;26(1):75-81, viii-ix.
Photopheresis and autoimmune diseases.
Division of Rheumatology, Wayne State University, Detroit, Michigan, USA. firstname.lastname@example.org
Although several case reports and case series suggest efficacy for photopheresis in the treatment of autoimmune diseases, few controlled studies have been conducted to test this hypothesis. After a decade of interest, multiple case reports, open trials, and one controlled study, the role of photopheresis in autoimmune disease remains to be established. Controlled multi-center trials in rheumatoid arthritis, SLE, and scleroderma may be costly but are clearly necessary for proper evaluation of this therapy