What are the treatment options for discoid lupus erythematosus?

From the Guidelines

Treatment options for discoid lupus erythematosus (DLE) include both topical and systemic approaches, with first-line treatment typically involving sun protection and high-potency topical corticosteroids, and antimalarials as the mainstay of systemic therapy for widespread or resistant disease. The goal of treatment is to reduce inflammation, suppress immune responses, and decrease keratinocyte proliferation, addressing the underlying autoimmune pathology of DLE.

Topical Treatments

• High-potency topical corticosteroids such as clobetasol propionate 0.05% applied twice daily to affected areas for 2-4 weeks, then tapered to maintenance use 1
• Topical calcineurin inhibitors like tacrolimus 0.1% ointment or pimecrolimus 1% cream as steroid-sparing alternatives, especially for facial or thin-skinned areas
• Intralesional corticosteroid injections (triamcinolone acetonide 2.5-10 mg/ml) can be administered directly into lesions every 3-4 weeks for resistant cases

Systemic Treatments

• Antimalarials, with hydroxychloroquine prescribed at 200-400 mg daily (not exceeding 5 mg/kg/day) for at least 2-3 months to assess efficacy, as recommended by the EULAR guidelines 1
• Patients on hydroxychloroquine require baseline and periodic eye examinations due to potential retinal toxicity
• For cases unresponsive to antimalarials, additional systemic options include methotrexate (7.5-25 mg weekly), mycophenolate mofetil (1-3 g daily), or oral retinoids like acitretin (25-50 mg daily) 1 It is essential to note that the treatment of DLE should be individualized, taking into account the severity of the disease, the presence of any comorbidities, and the patient's response to previous treatments. Regular follow-up and monitoring are crucial to adjust the treatment plan as needed and minimize potential side effects.

From the FDA Drug Label

1.4 Chronic Discoid Lupus Erythematosus Hydroxychloroquine sulfate tablets are indicated for the treatment of chronic discoid lupus erythematosus in adults. 2.5 Dosage for Chronic Discoid Lupus Erythematosus in Adults The recommended dosage is 200 mg given once daily, or 400 mg given once daily or in two divided doses.

The treatment option for discoid lupus erythematosus is hydroxychloroquine sulfate tablets. The recommended dosage is:

• 200 mg given once daily
• 400 mg given once daily
• 400 mg given in two divided doses 2.

From the Research

Treatment Options for Discoid Lupus Erythematosus

The treatment options for discoid lupus erythematosus (DLE) can be categorized into several groups, including:

• First-line options:
  • Sun protection 3, 4, 5
  • Topical corticosteroids 3, 6, 4, 5
  • Antimalarials 3, 6, 4, 5
• Alternative options for refractory cases:
  • Retinoids 3, 4, 5, 7
  • Methotrexate 3, 5, 7
  • Thalidomide 3, 5, 7
  • Topical tacrolimus 4, 5
  • Immunosuppressives like azathioprine, cyclosporine, mycophenolate mofetil 5, 7
  • Dapsone 7
  • High-dose intravenous immunoglobulins 7
  • Biologics (e.g., rituximab) 7

Efficacy of Treatment Options

Some studies have compared the efficacy of different treatment options, including:

• Fluocinonide 0.05% cream versus hydrocortisone 1% cream, with fluocinonide showing a 17% absolute benefit in favor of fluocinonide 6
• Acitretin versus hydroxychloroquine, with no significant difference between the two interventions, but more frequent and severe adverse effects with acitretin 6

Importance of Early Treatment

Early recognition and treatment of DLE can improve the prognosis and reduce the risk of scarring, hair loss, and hyperpigmentation changes in the skin 5