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Abstract

  1. Top of page
  2. Abstract
  3. Case Report
  4. Discussion
  5. References

Pulsed dye laser (PDL) has been used in adults to treat refractory cutaneous lupus erythematosus (CLE). We report the first case of CLE in a child successfully treated with PDL.

Adults with cutaneous lupus erythematosus (CLE) have been treated with pulsed dye laser (PDL) for approximately 30 years. We report the case of a young girl with refractory discoid CLE successfully treated with PDL.

Case Report

  1. Top of page
  2. Abstract
  3. Case Report
  4. Discussion
  5. References

A 9-year-old girl presented with a 1-year-history of erythematous annular macules and plaques with slight scaling located on the face and dorsum of both hands (Fig. 1) that worsened after sun exposure. The patient did not complain of arthralgias, malaise, or oral ulcers. A skin biopsy showed an atrophic epidermis, intense vacuolar degeneration of the basal layer, and dermal perivascular and periadnexal lymphocytic infiltrate. Routine laboratory tests showed an erythrocyte sedimentation rate of 17 mm/hour, normal complement levels, and negative antinuclear antibody. Discoid CLE was diagnosed and sunscreens, topical corticosteroids, and topical tacrolimus were prescribed. Because of a lack of response, oral hydroxychloroquine 200 mg/day was added. Some lesions improved slightly after 10 weeks, but most remained unchanged despite the treatment.

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Figure 1. Erythematous annular plaques in the malar area.

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It was decided to add a single session of 585-nm PDL (Cynergy Multiplex, Cynosure Inc., Westford, MA) using a 10-mm spot size at a 0.5-ms pulse width, a fluence of 5.5 J/cm2 on both cheeks, and 7 J/cm2 on the dorsum of the hands. The lesions on the back of the hands resolved completely after 1 month. In the facial area, the patient had transient hyperpigmentation that completely resolved 6 months after laser therapy (Fig. 2). The patient continues to use sunscreen and take 200 mg/day of hydroxychloroquine to prevent cutaneous flares and is currently free of CLE lesions after almost 2 years of follow-up. The plan is to stop the hydroxychloroquine after 2 years of good clinical control.

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Figure 2. Clinical improvement after 6 months of pulsed dye laser and hydroxychloroquine.

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Discussion

  1. Top of page
  2. Abstract
  3. Case Report
  4. Discussion
  5. References

Management of CLE includes photoprotection, topical corticosteroids, topical calcineurin inhibitors, and systemic antimalarial agents. Other systemic immunomodulators may be used if there is a lack of response. An alternative therapy in refractory lesions is PDL, which has been used in adults with active CLE lesions with good results and a good safety profile [1-7].

Endothelial cell activation is an important aspect in the physiopathogenesis of CLE [8]. Destruction of the cutaneous microvasculature and the reduction in the number of endothelial adhesion molecules such as intercellular adhesion molecule-1 and vascular cell adhesion molecule-1, decreasing the arrival of inflammatory cells into the dermis, may thus explain the therapeutic effect of PDL [7].

Worsening of CLE might appear after the use of lasers and is a matter of concern, although no case reports have been published reporting the exacerbation of cutaneous or systemic symptoms of lupus erythematosus in patients treated with PDL, which is highly selective for superficial dermal vessels. Regarding safety in children, PDL is currently the laser of choice to treat vascular lesions in children because of its high benefit-to-risk ratio [9].

Herein we report the first case of a child with CLE being treated with PDL. The patient did not show any worsening of the disease or any long-lasting side effects. Our findings suggest that PDL may be safe and effective for the treatment of pediatric CLE in patients refractory to conventional therapies.

References

  1. Top of page
  2. Abstract
  3. Case Report
  4. Discussion
  5. References