Dermatosurgical and Laser Therapy in Cutaneous Lupus Erythematosus

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In patients with treatment-resistant lesions, different surgical techniques may offer additional alternatives. For many years, cryotherapy has been used to treat LE lesions; however, systematic studies are lacking, and the reported numbers in treatment series are low (Ting and Sontheimer 2001). Further surgical techniques that have been reported in individual cases include dermabrasion, laser resurfacing, hair transplantation, and surgical excision of disfiguring lesions. Owing to the disease-specific nature of LE, a test area should probably be treated first so that avoidance of the Koebner phenomenon and adequate healing may be ensured.

Vascular lesions with telangiectasias on visible areas, such as the face, are common in DLE; however, efficient management of these skin lesions can sometimes be difficult. Since argon laser light can specifically coagulate vascular structures, it has been used in the treatment of various vascular skin malformations. Effective use of argon laser has been reported by two groups (Kuhn et al. 2000, Zachariae et al. 1988) (Table 25.1).

Single observations in the literature revealed successful treatment of cutaneous vascular lesions of LE with the carbon dioxide and the pulsed dye laser. In 1986, Henderson and Odom (Henderson and Odom 1986) treated characteristic plaques of

Table 25.1. Treatment of lupus erythematosus (LE) with laser: review of the literature. (Modified after Kuhn et al. 2000)



Indication (number of patients)

Type of laser


Side effects



DLE (1)




and Odom

dioxide laser

clinical and cosmetic improvement



Zachariae et al.

DLE (5)

Argon laser

Cosmetically satisfactory result

60%-70% permanent bleaching


Nunez et al.

LE teleangi-ectoides (1)


Excellent improvement



Nunez et al.

SLE (4)


Clearance in >75%

Slightly transient hyper-pigmentation


Nurnberg et al.

DLE (1)

Argon laser

Clinical and histologic improvement



Raulin et al.

DLE (8) CLE (1) SCLE (1) SLE (2)


Clearance rate of 70%

Transient hyperpigmen-



Kuhn et al.

DLE (1)

Argon laser

Complete resolution of lesions


CLE, cutaneous LE; DLE, discoid LE; FPDL, flashlamp pulsed dye laser; SCLE, subacute CLE; SLE, systemic LE.

CLE, cutaneous LE; DLE, discoid LE; FPDL, flashlamp pulsed dye laser; SCLE, subacute CLE; SLE, systemic LE.

a patient with DLE by using the carbon dioxide laser and observed a dramatic clinical and cosmetic improvement in the cutaneous lesions. Hypopigmentation in the tested areas and reactivation of DLE in the periphery were described as side effects. Nunez et al. (Nunez et al. 1995,1996) described telangiectatic chronic erythema of cutaneous lesions in four patients with systemic LE (SLE) who had been successfully treated with the flashlamp pulsed dye laser operating at 585 nm. Recently, Raulin et al. (Raulin et al. 1999) described a group of 12 patients with different forms of LE who were treated with the pulsed dye laser. A clearance rate was attained in 70% of the patients, and even in the two patients with SLE, a significant improvement was achieved. None of these patients showed any prolonged laser-induced scarring.

In 1988,Zachariae et al. (Zachariae et al. 1988) reported for the first time the treatment of cutaneous vascular lesions in connective tissue diseases with the argon laser. They noticed significant blanching of the patches, although scarring and hyperpig-mentation remained. Since then, only one further report in the German literature (Nurnberg et al. 1996) documented successful treatment with the argon laser of skin lesions on the extensor aspect of the arms in one patient with chronic DLE. In contrast, Wolfe et al. (Wolfe et al. 1997) suggested that overtreatment with an argon laser has the potential to induce DLE since thermal injury seems to have caused the Koeb-ner phenomenon in a patient without any previous history of autoimmune disease. The induction of such isomorphic skin changes after cutaneous injury in previously uninvolved skin has been associated with DLE (Ueki 1994, Wolfe et al. 1997).

The argon laser seems to be a promising alternative for the treatment of vascular DLE skin lesions, with an excellent cosmetic result. However, the indication must be carefully evaluated and the risks and benefits should be precisely documented, as skin texture changes and scarring might occur

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