From the Guidelines
For a red scaly rash on the back of the neck in a patient with systemic lupus erythematosus (SLE), I recommend starting with a medium-potency topical corticosteroid such as triamcinolone 0.1% cream applied twice daily for 7-14 days, as first-line treatment of skin disease in SLE includes topical agents (GC, calcineurin inhibitors) 1. This rash likely represents either a cutaneous manifestation of SLE (discoid or subacute cutaneous lupus) or seborrheic dermatitis, which is common in this location. If the rash doesn't improve within two weeks, consider adding a topical calcineurin inhibitor like tacrolimus 0.1% ointment twice daily. Sun protection is essential, so advise the patient to apply SPF 50+ sunscreen daily and wear protective clothing, as UV exposure can trigger or worsen cutaneous lupus lesions. For persistent or severe lesions, systemic therapy may be necessary, including hydroxychloroquine 200-400mg daily, which helps manage both cutaneous manifestations and underlying SLE, as recommended for all patients with SLE unless contraindicated, at a dose not exceeding 5 mg/kg real body weight 1. Topical corticosteroids work by reducing inflammation and immune response in the skin, while calcineurin inhibitors inhibit T-cell activation without the side effects of steroids. A dermatology referral is warranted if the rash persists despite these interventions to confirm diagnosis with possible biopsy and adjust treatment accordingly. In non-responsive cases or cases requiring high-dose GC, methotrexate can be added, as it has been shown to be effective in controlling systemic lupus erythematosus (SLE) and allow reduction in corticosteroid dose 1.
From the FDA Drug Label
1.3 Systemic Lupus Erythematosus Hydroxychloroquine sulfate tablets are indicated for the treatment of systemic lupus erythematosus in adults. 2.4 Dosage for Systemic 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 for a red scaly rash on the back of the neck in a patient with a history of Systemic Lupus Erythematosus (SLE) may involve hydroxychloroquine sulfate tablets, as they are indicated for the treatment of SLE in adults. The recommended dosage is 200 mg given once daily, or 400 mg given once daily or in two divided doses 2. However, it is essential to note that the drug label does not specifically address the treatment of a red scaly rash on the back of the neck.
- Key points:
- Hydroxychloroquine sulfate tablets are indicated for SLE treatment.
- The recommended dosage for SLE is 200 mg or 400 mg daily.
- The drug label does not directly address the treatment of a red scaly rash on the back of the neck in SLE patients.
From the Research
Treatment for Red Scaly Rash on the Back of the Neck in SLE Patients
- The treatment for a red scaly rash on the back of the neck in a patient with a history of Systemic Lupus Erythematosus (SLE) typically involves the use of hydroxychloroquine, which is considered the standard of care for SLE 3.
- Hydroxychloroquine has been shown to decrease SLE activity, prevent disease flare, and lower the long-term glucocorticoid need 4.
- In addition to hydroxychloroquine, other treatments such as immunosuppressive agents (e.g. azathioprine, mycophenolate mofetil, cyclophosphamide) and biologic therapies (e.g. belimumab, voclosporin, anifrolumab) may be used to treat moderate to severe disease 3, 5.
- The use of glucocorticoids, such as methyl-prednisolone pulses, may also be considered for inducing rapid remission, with doses ≤5-2.5 mg/day recommended for long-term maintenance treatments 6.
- Hydroxychloroquine has been shown to modulate elevated expression of S100 proteins in SLE patients, which may improve organ involvement, especially in patients with renal or skin involvement 7.
Dosage and Administration
- The daily dose of hydroxychloroquine associated with the best compromise between efficacy and safety is a matter of debate, with a daily dose of ≤5 mg/kg/day actual body weight currently agreed upon 4.
- Stable doses of 200 mg/day of hydroxychloroquine may accomplish good control of lupus without compromising safety 6.