Efficacy and safety of pulsed dye laser treatment for cutaneous discoid lupus erythematosus

• Published in: Journal of the American Academy of Dermatology 2009-04, Vol.60 (4), p.626-632
• Main Authors: Erceg, Angelina, MD, Bovenschen, H. Jorn, MD, PhD, van de Kerkhof, Peter C.M., MD, PhD, de Jong, Elke M.J.G., MD, PhD, Seyger, Marieke M.B., MD, PhD
• Format: Article
• Language: English
• Subjects: Adult; Aged; Biological and medical sciences; Dermatology; Female; Humans; Lasers, Dye - adverse effects; Lasers, Dye - therapeutic use; Lupus Erythematosus, Discoid - surgery; Male; Medical sciences; Middle Aged; Prospective Studies; Sarcoidosis. Granulomatous diseases of unproved etiology. Connective tissue diseases. Elastic tissue diseases. Vasculitis
• ISSN: 0190-9622; 1097-6787
• DOI: 10.1016/j.jaad.2008.11.904

Background Treatment of chronic discoid lupus erythematosus (CDLE) with a pulsed dye laser (PDL) has shown promising results, although outcomes in previous studies were not validated and laser parameters were inconsistent. Objective We conducted an open prospective study to assess the efficacy and safety of PDL for the treatment of recalcitrant CDLE, using a validated scoring method and a fixed treatment schedule. Methods Twelve patients with active CDLE lesions were treated with PDL (585 nm, fluence 5.5 J/cm2 , spot size 7 mm) 3 times with an interval of 6 weeks followed by a 6-week follow-up period. Treatment outcomes were evaluated by 3 observers using the validated Cutaneous Lupus Erythematosus Disease Area and Severity Index (CLASI). Cosmetic results and adverse events were recorded. Results A significant decline in “active” CLASI was observed after 6 weeks, after 12 weeks, and at follow-up. Baseline active CLASI was 4.4 ± 0.2 (mean ± SEM), reaching 1.3 ± 0.3 after follow-up ( P < .0001). Individual scores for erythema and scaling/hypertrophy significantly declined 6 weeks after treatment. The “damage” CLASI (dyspigmentation, scarring, and atrophy) did not show any significant change during or after therapy. The observed clinical improvement was confirmed by two independent observers by clinical assessment of photographs ( r = 0.87 and r = 0.89; both P < .05). The treatment was well tolerated, only minimal pain was reported, and the cosmetic result was fair. Limitations Small sample size and short follow-up duration were limitations. Conclusion PDL treatment is an effective and safe therapy for patients with refractory CDLE.