Suspect cutaneous lupus erythematous in older patients with photosensitive rash

Cutaneous lupus erythematous (CLE) is an autoimmune dermatological disorder that typically presents with photosensitivity. CLE in older patients is characterised by more drug-induced and other subacute CLE, and a generally milder and shorter disease course. This is balanced by an increased susceptibility to adverse drug events such as skin atrophy. Eliminating possible precipitating medications (e.g. thiazide diuretics, antifungals) and sun avoidance with vitamin D monitoring are key preventative strategies. Topical corticosteroids and calcineurin inhibitors are first-line therapies, then systemic agents such as the antimalarial hydroxychloroquine, short-term corticosteroids and immune modulators. Renal and hepatic compromise may limit options.