Winkelmann R R, Kim Grace K, Del Rosso James Q
Ohio University Heritage College of Osteopathic Medicine, Athens, Ohio;
J Clin Aesthet Dermatol. 2013 Jan;6(1):27-38.
The treatment of cutaneous lupus erythematosus is centered upon formulating a regimen of topical and systemic therapies designed to reduce disease activity and minimize cosmetic damage. Sun avoidance and sunscreen are important preventative measures proven to minimize cutaneous lupus erythematosus exacerbations. Limited disease is typically managed with topical corticosteroids or calcineurin inhibitors. Antimalarial therapy is the gold standard of systemic therapy. Many other treatments have been studied in patients with recalcitrant cutaneous lupus erythematosus, and their use must be evaluated based on individual risk-benefit concerns. R-salbutamol and pulsed dye laser therapy have proven to be effective topical alternatives. Additional systemic agents include retinoids, immunosuppressants, immunomodulators, biologics, and other experimental therapies with novel modes of action. According to the Oxford Centre for Evidence-based Medicine criteria for evaluating the strength of evidence supporting an individual treatment measure, no therapy for cutaneous lupus erythematosus has achieved Level 1 status. This demonstrates the need for randomized, controlled trials and systematic reviews of all cutaneous lupus erythematosus interventions in order to meet increasing standards and demand for evidence-based practice.
皮肤红斑狼疮的治疗重点在于制定局部和全身治疗方案，以降低疾病活动度并尽量减少美容损害。避免日晒和使用防晒霜是经证实可尽量减少皮肤红斑狼疮病情加重的重要预防措施。局限性疾病通常采用局部糖皮质激素或钙调神经磷酸酶抑制剂治疗。抗疟药疗法是全身治疗的金标准。对于难治性皮肤红斑狼疮患者，已对许多其他治疗方法进行了研究，必须根据个体的风险效益考虑来评估其使用情况。R-沙丁胺醇和脉冲染料激光疗法已被证明是有效的局部替代疗法。其他全身用药包括维甲酸、免疫抑制剂、免疫调节剂、生物制剂以及其他具有新型作用模式的实验性疗法。根据牛津循证医学中心评估支持个体治疗措施证据强度的标准，尚无针对皮肤红斑狼疮的治疗方法达到1级地位。这表明需要对所有皮肤红斑狼疮干预措施进行随机对照试验和系统评价，以满足循证实践日益提高的标准和需求。
