Fraxel Laser to Treat Discoid Lupus?

Question

I suffer from discoid lupus on my face, neck and back. Would the Fraxel laser remove the lesions?  Other steriod topicals and malaria drugs did not work.

Ron Shelton, MD · Answer

Discoid lupus erythematosus is a chronic skin condition that may be active or mature and "burned out." The depressions centrally in the lesions of DLE may improve with Fraxel but this is risky as there may be a greater chance of post inflammatory hyperpigmentation in your skin causing darker brown spots. Even if the scars raise they the skin will not look like normal tissue. Lastly, there is a chance that DLE can be exacerbated by trauma. This is called the Koebner response or reacion. It is possible that the Fraxel or any laser might induce this kind of stimulation and the DLE milght worsen. If you and your physician are contemplating this, conside a test area, such as behind your ear to see if the skin tolerates the Fraxel. Wait about six weeks to see if there is anything unusual developing in the laser site. Then you could even consider treating only one small lesion on the forehead as a second tes before treating all. Good luck.

Michael A. Persky, MD · Answer

Hi Cat,
I have not heard of or seen any literature regarding the treatment of discoid lupus with Fraxel or any other laser treatment.  I will further look into this for you. Hopefully, some of the other experienced laser physicians out there in RealSelf world can share their experience with you.
Good luck and be well.
Dr. P

Arnold R. Oppenheim, MD (retired) · Answer

Discoid lupus erythematosus (DLE) is a chronic, scarring photodermatosis which occasionally occurs in patients with systemic lupus but usually occurs on its own. About 5% of patients with DLE go on to develop the far more serious and less common systemic lupus. Sun avoidance is of paramount importance. The one patient of mine who died from SLE began with discoid lupus, liked gardening, did not heed my advice and her rather tame DLE turned into the ravenous wolf which is systemic lupus. 
Anti-malarials such as Plaquanil are usually successful in treating the lesions of discoid lupus. Hopefully, you do not smoke. There have been a number of papers showing that smoking decreases the effectiveness of DLE. So if you smoke...quit... it might make the Plaquanil work better.
It practically goes without saying that you should be assiduous in wearing sun screens and adequate clothing. 
Besides topical steroids the calcineurin inhibitors such as Protopic or Elidel are also commonly used. 
If Plaquanil does not work, Thalomid, may be added. Yes, that thalidomide, the horror of the 1950's and one of the great pat-on-the-back stories for the FDA. ( The FDA held up the approval of this drug as reports of its teratogenicity among European babies began to filter in. I remember going to the Brockton Fair as a teen and seeing some thalidomide babies in a side-show. We have better sensitivities today and I doubt whether that sort of exploitation would be tolerated today.)
I have found intralesional injections of steroids ( triamcinolone acetonide 3 mg/ml) to be the most effective treatment for this condition. 
Systemic treatment with Dapsone and in some cases Mycophenolate Mofetil ( Cell-Cept) or Azathioprine by be used. All three of these are big time drugs with the attendant side effects.
As far as laser treatment, I do not know of any studies using a Fraxel. There was a recent  paper in the April 2009 issue of the Journal of the American Journal of Dermatology by Erceg et al that demonstrated success with the pulsed dye laser in treating the lesions of DLE. Off hand, if you want to go the laser route, I would chose this laser over the Fraxel. At least until the latter has been studied.
I would return to the dermtologist who has been treating you. He/she has a number of options remaining in treating your problem.

Fraxel Laser to Treat Discoid Lupus?

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