Educational draft · awaiting clinical reviewUse Rapid for revision, not patient-care decisions. Check current national and local guidance and the BNF or BNFC before acting.
2 min synopsisUK scopeSources checked 27 Aug 2026Clinical review pending
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Skin lupus with threatened organ disease
New haematuria, proteinuria, hypertension, chest pain, breathlessness, focal neurology, confusion, severe cytopenic symptoms or pregnancy morbidity can indicate systemic lupus affecting kidney, heart, lung, brain or blood.
Action: Check observations, blood pressure, urine, renal function, blood count and the threatened organ urgently and involve rheumatology plus the relevant acute specialty; topical escalation must not delay organ assessment.
Synopsis
Classify acute, subacute and chronic cutaneous lupus, detect systemic organ involvement, prevent ultraviolet and scarring damage, and use local or antimalarial treatment with reproductive and retinal safeguards.
Acute cutaneous lupus includes a photosensitive malar eruption that often spares nasolabial folds and usually tracks active systemic lupus rather than existing as an isolated diagnosis.
Subacute cutaneous lupus forms annular polycyclic or papulosquamous lesions on upper trunk and arms, commonly associates with anti-Ro antibodies and can be medicine induced.
Discoid lupus produces adherent scale, dyspigmentation, follicular plugging and atrophic scar on face, ears or scalp; destroyed hair follicles do not regrow.
Key red flags
Rapidly ulcerating or vasculitic skin, digital ischaemia, extensive blistering, fever, mucosal disease, progressive scarring scalp loss or systemic symptoms requires urgent dermatology and rheumatology assessment.
Vasculitic or systemic warning
Retiform purpura, ulcers, digital ischaemia, oedema, hypertension, chest or neurological symptoms shifts urgency toward systemic organ disease.
Investigation priorities
01
Routine histology from an active lesionFirst step
Confirm interface dermatitis, follicular involvement and mucin while excluding infection or malignancy.
Management branches
First diagnostic sequenceSubtype the skin and screen the organs
A photosensitive, annular or scarring eruption suggests cutaneous lupus.
Map distribution, scale, follicular openings, scar and pigment in neutral light, ask about light, smoking, medicines and systemic symptoms and photograph activity with consent.
Biopsy an active representative site for routine histology and add correctly planned direct immunofluorescence only when it will resolve a meaningful uncertainty.
First-line preventionReduce ultraviolet and smoke amplification
Cutaneous lupus is confirmed or strongly supported regardless of current treatment intensity.
Key medicines
HydroxychloroquineTake 200–400 mg by mouth once daily with food, using the lowest effective dose and never exceeding 5 mg/kg actual body weight per day.
Site-appropriate topical corticosteroidApply a thin layer once daily to active plaques for the prescribed two-to-six-week course, then stop, reduce or use intermittently only after review.
National guidance is shown before implementation-dependent detail. Typical adult dose examples remain subject to patient factors, contraindications and the live BNF or specialist protocol. Source check completed 27 Aug 2026; clinical approval remains outstanding.