Subacute cutaneous lupus erythematosus (SCLE) is a rash that can occur in people with or without systemic lupus. Treatments may include medications and minimizing sun exposure. The rash usually resolves over time and does not scar the skin.

SCLE is a skin rash that can occur as a complication of lupus or due to genetics, environmental factors, or certain medications. The rash can spread across the body, typically affecting the arms, back, and chest.

SCLE causes a ring-shaped rash on sun-exposed areas of skin, such as the torso and arms. It does not usually occur on the face.

This article looks at the symptoms, causes, diagnosis, treatment, and outlook for SCLE.

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According to the American Osteopathic College of Dermatology (AOCD), SCLE may affect 50% of people with systemic lupus erythematosus (SLE).

SLE is more common in females, up to middle age, and is 3–4 times more likely in females than males.

The average age of people with cutaneous lupus is 50–52 years. SCLE due to medications may present at older ages and in males or females.

People with other conditions may also develop SCLE, as it can link to the following conditions:

The SCLE rash usually affects sun-exposed areas of the body in a symmetrical pattern on the neck, torso, and arms. SCLE does not usually affect the face.

Symptoms of SCLE include:

  • raised, scaly lesions or plaques on the skin
  • circular-shaped lesions with distinct edges, which may appear red on light skin tones or dark purple or brown on dark skin tones
  • rash potentially including fluid-filled blisters in some diagnoses

SCLE usually heals without scarring the skin. The rash can cause skin discoloration, but this usually resolves over time.

According to AOCD, around 50% of people with SCLE may also experience joint pain, usually within small joints, such as the hands or wrists.

Find rash images in a visual guide to lupus.

Other forms of cutaneous lupus

SCLE is one subtype of cutaneous lupus. The other types are:

  • Acute cutaneous lupus: This tends to coincide with a systemic lupus flare-up and causes a “butterfly” rash and swelling across the cheeks.
  • Chronic cutaneous lupus or discoid lupus: Chronic cutaneous lupus or discoid lupus causes round sores, typically on the face, ears, and scalp. It can also cause scars and skin discoloration.
  • Intermittent cutaneous lupus (lupus tumidus): This condition is characterized by round papules and plaques with a smooth surface. It occurs on sun-exposed areas of skin and resolves over winter without scarring.

Read more about cutaneous lupus.

According to the Lupus Foundation of America, SCLE may occur on its own or as a complication of systemic lupus.

DermNet reports that around 20–40% of SCLE diagnoses occur due to, or become worse due to, medications such as proton pump inhibitors and calcium channel blockers. This includes:

SCLE may begin months or years after using these drugs.

SCLE can have a genetic cause and may occur due to the presence of specific genes, deficiencies in certain proteins, or changes in the DNA sequence of some genes.

Environmental factors may also trigger autoimmune responses, which can cause SCLE. These include:

SCLE may also occur with certain cancers, such as:

To diagnose SCLE, doctors may carry out a physical examination to assess the skin and symptoms. They will request a full medical history and review any medications people take that may be linked to SCLE.

Tests to diagnose SCLE may include:

SCLE treatment includes lifestyle changes and medical treatments.

According to the AOCD, the most effective SCLE treatment is protecting the skin from the sun. This includes:

  • minimizing sun exposure
  • wearing sun-protective clothing and wide-brimmed hats
  • using a broad-spectrum sunscreen with a minimum of SPF 50, which people need to apply 20–30 minutes before sun exposure

Tobacco use can increase sensitivity to the sun. If a person smokes, quitting tobacco use can help reduce their risk of sun sensitivity.

Treatment may also include corticosteroids, which a person can take orally, as a topical treatment, or as an injection into the affected skin. Other medications may include:

People with SCLE may have low vitamin D levels, so they may require a vitamin D and calcium supplement. If you’re considering supplementation, talk with a healthcare professional first. They can determine if it’s right for you.

Due to increased sun protection, people with SCLE may have an increased risk of vitamin D deficiency. People may need to take vitamin D and calcium supplements to prevent this.

In rare cases, SCLE may affect large areas of the body and cause significant discomfort or negatively affect quality of life.

SCLE may affect the entire body, leading to complications involving vital organs. Around 10–15% of people with SCLE develop lupus. This may affect the kidneys and the nervous system.

More than 8O% of people with SCLE have Ro/SSA antibodies. A pregnant person who is Ro/SSA antibody-positive has an 8–10% chance of delivering an infant with neonatal lupus erythematosus. They also have a 1–2% chance of delivering an infant with congenital heart block.

Learn more about lupus.

SCLE usually has a positive response to treatment. If medications are causing SCLE, symptoms may take several weeks to resolve after stopping the drug.

People may continue to have SCLE flare-ups during the summer months. Around 10–15% of people with SCLE may develop lupus.

SCLE usually heals without scarring. It may leave some skin discoloration, but in most diagnoses, the skin will return to normal.

SCLE is a rash with raised, ring-shaped plaques with clear centers. The rash usually occurs on the back, chest, or arms.

SCLE may occur due to genetics, environmental triggers, medications, or as a complication of systemic lupus.

A key treatment for SCLE is sun protection through SPF50+ sunscreen, protective clothing, and minimizing sun exposure. Medications such as corticosteroids or hydroxychloroquine may also help.

SCLE will usually resolve over time with no scarring but may reoccur in the summer months.