This protocol addresses subacute cutaneous lupus erythematosus (SCLE) in patients presenting with severe or widespread skin lesions, or in whom there is a meaningful risk of scarring or progression to systemic disease. These features place the patient in a higher-risk category that calls for a more comprehensive first-line strategy than localised or mild disease.
Severe or widespread cutaneous involvement — particularly when scarring or systemic involvement are possible outcomes — warrants prompt systemic treatment alongside topical therapy. Antimalarials are recommended as the cornerstone of long-term systemic management in this population, with additional measures for active, widespread lesions.
The first-line strategy for this presentation combines a time-limited course of topical corticosteroids with antimalarial therapy, which forms the backbone of ongoing systemic management. For patients with severe or widespread active lesions, systemic corticosteroids are added as part of the initial treatment alongside the antimalarial.