Acute cutaneous lupus erythematosus (ACLE)

Last Updated: 2019-08-27

Author(s): Anzengruber, Navarini


Rare, acute form of cutaneous lupus erythematosus.


  • Localization
    • UV-exposed areas.
  • A rather sharp and regularly limited, often butterfly-shaped erythema with discrete flaking that occurs over days to weeks.
  • In the generalized form, a morbilliform or maculopapular exanthema appears.
  • Palmoplantar and finger involvement is possible. Enanthema and oral erosions occur in up to 45% of patients.
  • When the hair is thinning out, it is called lupus hair.


  • S. Cutaneous lupus erythematosus.
  • Note:
  • In ACLE, serological clarification is usually unspecific.
  • Ro-, La- -antibodies may be elevated.
  • Anti-ds-DNA-Ab are increased in up to 90%.
  • In almost 30% are found positive anti-Sm-Ab.

S. Cutaneous lupus erythematosus.

  • S. Cutaneous lupus erythematosus.


Avoid common mistakes:

  • Medical history should always include sensitivity to light.
  • Drug history to exclude drug-induced lupus erythematosus.
  • Family and personal anamnesis after autoimmune diseases.
  • Do not overestimate the ARA criteria! The ARA criteria are only conditionally suitable for the exclusion of systemic lupus erythematosus.
  • Avoid a purely superficial biopsy.
  • A therapy should not be changed until the preventive measures to avoid possible trigger factors have been exhausted and sun protection with a high sun protection factor is applied daily!


  1. Walling HW, Sontheimer RD. Cutaneous lupus erythematosus: issues in diagnosis and treatment. Am J Clin Dermatol 2009;10:365-81.
  2. Okon LG, Werth VP. Cutaneous lupus erythematosus: diagnosis and treatment. Best Pract Res Clin Rheumatol 2013;27:391-404.
  3. Kuhn, A. (2016). S1-Leitlinie: Kutaner Lupus Erythematodes. Retrieved 30 May 2016, from