5th June 2025

Management

Treatment is divided into preventative measures, topical therapy and systemic therapy.

Preventative measures to minimise flares and organ damage include:

• Diligent minimisation of sun exposure with clothes, accessories, sunscreen
• Smoking cessation
• Psychological interventions

Topical therapy includes potent topical corticosteroids and calcineurin inhibitors (tacrolimus ointment and pimecrolimus cream).

Systemic therapy choice depends on which organ systems are most affected. The medications generally used are as follows:

• NSAIDs – first line for musculoskeletal stiffness or pain
• Hydroxychloroquine – recommended in all SLE patients; response rates are about 80% in CLE; risk of retinal toxicity
• Corticosteroids – mainstay of treatment in the ill SLE patient; can give intravenous methylprednisolone for immediate therapeutic effect before switching to oral
• Immunosuppressive agents include methotrexate, azathioprine, mycophenolate
• Biological agents – B-cell targeting agents such as belimumab and rituximab