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Laser therapy for refractory discoid lupus erythematosus when everything else has failed

Abstract Background: Discoid lupus erythematosus (DLE) is restricted to the skin, mostly the face, often chronic and disfiguring. Standard medical therapies include topical corticosteroids and antimalarials. This is a retrospective long-term follow-up of refractory DLE treated with different lasers and intense pulsed light (IPL). Methods and materials: Sixteen patients with histologically confirmed DLE participated in this study. Two men and fourteen women, aged 28–69 years, mean age 54 years, were treated at the laser units of the Departments of Dermatology at the University Hospital of Örebro from 2001 and at Skåne University Hospital in Malmö, Sweden from 1999. Several therapies, including first- and second-line treatments and even cryotherapy, had been used without response. Many patients had marked scarring. Pulsed dye laser (PDL) and IPL were used with low fluencies. Results: Of 16 patients, 14 were improved regarding itching, erythema, scaling, scarring and pain. There was no scarring as a side effect of laser therapy or IPL. Two patients were not satisfied: one because of long healing time, and the other because of post inflammatory hyper pigmentation. Conclusion: IPL and PDL is a safe adjunctive therapy to conventional treatment of DLE. In the effort to prevent severe scarring and disfigurement it should be used as early as possible.