Psychological effects of cutaneous lupus erythematosus

Author: Brian Wu, MD candidate, Keck School of Medicine, Los Angeles, USA. DermNet New Zealand Editor in Chief: Hon A/Prof Amanda Oakley, Dermatologist, Hamilton, New Zealand. Copy editor: Maria McGivern. March 2017.


What is lupus erythematosus?

Lupus erythematosus (LE) is a group of chronic, autoimmune diseases that may affect multiple organs. It often involves the skin, with acute, subacute, intermittent, chronic and nonspecific forms. Cutaneous disease is a feature of systemic LE in around 70% of patients.

Common manifestations of cutaneous LE include:

Cutaneous LE can have a profound effect on the individual’s mental and physical health.

Who gets the psychological effects of cutaneous lupus erythematosus?

The cutaneous manifestations of LE often result in depression and psychological stress. It is estimated that 20–40% of patients with cutaneous LE suffer from emotional problems.

What are the psychological effects of cutaneous lupus erythematosus?

Cutaneous LE affects nearly every aspect of a person’s life, including their family and other social relationships.

  • Patients report being extremely self-conscious and distressed about their appearance as well as being socially stigmatised.
  • Cutaneous LE also interferes with leisure activities due to the need to avoid sunlight.
  • Feelings of helplessness and feeling trapped by the disease are frequently reported, due to the chronicity of lupus and its lack of cure.

The very poor quality of life seen in patients with cutaneous LE is comparable to that seen in patients with other serious chronic conditions such as congestive heart failure and diabetes.

How are the psychological effects of cutaneous lupus erythematosus measured?

The Cutaneous Lupus Activity and Severity Index (CLASI) is a tool that is used to assess the effects of cutaneous LE on the individual. It ranks the activity of the disease on a scale of 0–70 (the higher the number, the greater the severity) and the damage it has done on a scale of 0–56 (the higher the number, the larger the level of dyspigmentation and scarring).

The Skindex-29 questionnaire and the Dermatology Life Quality Index (DLQI) can also be used to assess quality of life for patients with chronic skin conditions, including cutaneous LE.

How are the psychological effects of cutaneous lupus erythematosus treated?

The treatment for cutaneous LE may require collaboration between a dermatologist and a psychologist or psychiatrist to deal with both the physical and psychological effects of the disease.

Treatment includes:

  • The use of sunscreen and protective clothing to prevent skin exposure to sunlight
  • Topical and systemic treatments for the skin disease
  • Antidepressants
  • Stress management
  • Patient support groups
  • Psychiatric treatment, including behavioural alteration and cognitive behavioural therapy.

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References

  • Eastham ABW; Medscape. Discoid lupus erythematosus. 26 February 2016. Available at: http://emedicine.medscape.com/article/1065529-overview (accessed 31 January 2017).
  • Klein R, Moghadam-Kia S, Taylor L, et al. Quality of life in cutaneous lupus erythematosus. J Am Acad Dermatol 2011; 64: 845–58. DOI: 10.1016/j.jaad.2010.02.008. PubMed Central
  • Uva L, Miguel D, Pinheiro C, et al. Cutaneous manifestations of systemic lupus erythematosus. Autoimmune Diseases 2012; vol 2012: Article ID 834291, [15 pages]. DOI: 10.1155/2012/834291. Journal
  • Verma SM, Okawa J, Propert KJ, Werth VP. The impact of skin damage due to cutaneous lupus on quality of life. Br J Dermatol 2014; 170: 315–21. DOI: 10.1111/bjd.12653. PubMed Central
  • Klein RS, Morganroth PA, Werth VP. Cutaneous lupus and the CLASI instrument. Rheum Dis Clin North Am 2010; 36: 33–51. DOI: 10.1016/j.rdc.2009.12.001. PubMed Central

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