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Medication

Medication Summary

Hydroxychloroquine and chloroquine phosphate have shown beneficial effects in treating discoid lupus erythematosus (DLE). Additionally, the antimalarial drugs may prevent the development of systemic lupus erythematosus (SLE) in patients with DLE, and they might decrease the risk of cardiovascular disease.^[27]Alternative therapies, anecdotal reports, and small open-label trials (as reported by Callen^[60]) suggest that the following agents may be useful in some patients:

Methotrexate ^[29]
Mycophenolate mofetil ^[48]
Azathioprine ^[30]
Thalidomide ^{[61, 62, 63, 64]}
Lenalidomide ^{[50, 51]}
Isotretinoin ^[65]
Acitretin
Dapsone
Auranofin
Phenytoin
Fumaric acid esters ^[66]
Photodynamic therapy ^[67]
Imiquimod cream 5% ^[68]
Intravenous immunoglobulin ^[54]
Belimumab ^{[55, 56]}
Tofacitinib ^{[7, 52]}
Apremilast ^[53]
Sirolimus ^[57]

Class Summary

Antimalarial agents may have immunomodulatory properties. Hydroxychloroquine is the drug of choice when a systemic agent is needed for discoid lupus erythematosus (DLE). Chloroquine is second-line antimalarial therapy. Chloroquine and hydroxychloroquine should not be used in combination due to the increased risk of ocular toxicity. The antimalarial drugs may prevent the development of systemic lupus erythematosus (SLE) in patients with DLE, and they might decrease the risk of cardiovascular disease.

Hydroxychloroquine (Plaquenil)

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Hydroxychloroquine is used for the treatment of DLE and SLE. It inhibits chemotaxis of eosinophils and locomotion of neutrophils and impairs complement-dependent antigen-antibody reactions. Hydroxychloroquine sulfate 200 mg is equivalent to 155 mg hydroxychloroquine base and 250 mg chloroquine phosphate.

Chloroquine (Aralen)

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Chloroquine inhibits chemotaxis of eosinophils and locomotion of neutrophils and impairs complement-dependent antigen-antibody reactions.

Class Summary

Leprostatic agents may modulate the immune system.

Dapsone

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Dapsone's mechanism of action is similar to that of sulfonamides, in which competitive antagonists of para-aminobenzoic acid (PABA) prevent the formation of folic acid, inhibiting bacterial growth. The anti-inflammatory action may relate to suppression of neutrophil function by inhibition of the halide-myeloperoxidase system.

Class Summary

Gold compounds have proven effective in the treatment of inflammation with autoimmune etiology.

Auranofin (Ridaura)

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Gold is taken up by macrophages, which, in turn, inhibit phagocytosis and lysosomal membrane stabilization. Gold alters immunoglobulins, decreasing prostaglandin synthesis and lysosomal enzyme activity.

Class Summary

Immunomodulators affect factors that regulate the immune system.

Methotrexate (Rheumatrex, Trexall)

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Methotrexate reversibly inhibits dihydrofolate reductase; it limits the availability of 1-carbon fragments necessary for the synthesis of purines and the conversion of deoxyuridylate to thymidylate in the synthesis of DNA and cell reproduction. Methotrexate is extensively used to treat cancer, rheumatoid arthritis, and psoriasis and is used as a steroid-sparing agent in various autoimmune conditions.

Thalidomide (Thalomid)

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Thalidomide is an immunomodulatory agent that may suppress excessive production of tumor necrosis factor (TNF)-alpha and may down-regulate selected cell-surface adhesion molecules involved in leukocyte migration. If the patient weighs less than 50 kg (110 lb), start the individual at the low end of the dose regimen.

Azathioprine (Imuran, Azasan)

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Azathioprine antagonizes purine metabolism and inhibits the synthesis of DNA, ribonucleic acid (RNA), and proteins. It may decrease the proliferation of immune cells, which results in lower autoimmune activity.

Mycophenolate (CellCept, Myfortic)

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Mycophenolate inhibits inosine monophosphate dehydrogenase and suppresses de novo purine synthesis by lymphocytes, thereby inhibiting their proliferation. It inhibits antibody production.

Class Summary

Corticosteroids are anti-inflammatory agents that suppress the immune system at several levels, including through the inhibition of inflammatory cells and the production of antibodies.

Triamcinolone (Kenalog-10)

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Triamcinolone can be administered intralesionally in a concentration of 3-5 mg/mL. The amounts injected should be recorded. Systemic adverse effects are uncommon with low doses. Atrophy is possible and is dose dependent.

Class Summary

Retinoids have the ability to regulate cell proliferation and the immune system.

Acitretin (Soriatane)

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Acitretin is a retinoic acid analog similar to etretinate and isotretinoin. Etretinate is the main metabolite, and acitretin has demonstrated clinical effects close to those seen with etretinate. The mechanism of action is unknown.

Isotretinoin (Claravis, Sotret, Amnesteem)

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Isotretinoin is a synthetic 13-cis isomer of naturally occurring tretinoin (trans -retinoic acid). Both agents are structurally related to vitamin A. Isotretinoin decreases sebaceous gland size and sebum production. It may inhibit sebaceous gland differentiation and abnormal keratinization.

A US Food and Drug Administration (FDA)–mandated registry is now in place for all individuals prescribing, dispensing, or taking isotretinoin. For more information on this registry, see iPLEDGE. This registry aims to decrease the risk of pregnancy and unwanted and potentially dangerous adverse effects during a course of isotretinoin therapy.

Questions

Grönhagen CM, Fored CM, Granath F, Nyberg F. Cutaneous lupus erythematosus and the association with systemic lupus erythematosus: a population-based cohort of 1088 patients in Sweden. Br J Dermatol. 2011 Jun. 164(6):1335-41. [QxMD MEDLINE Link].
Wieczorek IT, Propert KJ, Okawa J, Werth VP. Systemic symptoms in the progression of cutaneous to systemic lupus erythematosus. JAMA Dermatol. 2014 Mar. 150 (3):291-6. [QxMD MEDLINE Link].
Prystowsky SD, Gilliam JN. Discoid lupus erythematosus as part of a larger disease spectrum. Correlation of clinical features with laboratory findings in lupus erythematosus. Arch Dermatol. 1975 Nov. 111(11):1448-52. [QxMD MEDLINE Link].
Elman SA, Joyce C, Costenbader KH, Merola JF. Time to progression from discoid lupus erythematosus to systemic lupus erythematosus: a retrospective cohort study. Clin Exp Dermatol. 2020 Jan. 45 (1):89-91. [QxMD MEDLINE Link].
Petri M, Orbai AM, Alarcón GS, et al. Derivation and validation of the Systemic Lupus International Collaborating Clinics classification criteria for systemic lupus erythematosus. Arthritis Rheum. 2012 Aug. 64 (8):2677-86. [QxMD MEDLINE Link].
Lehmann P, Hölzle E, Kind P, Goerz G, Plewig G. Experimental reproduction of skin lesions in lupus erythematosus by UVA and UVB radiation. J Am Acad Dermatol. 1990 Feb. 22(2 Pt 1):181-7. [QxMD MEDLINE Link].
Kahn JS, Deverapalli SC, Rosmarin DM. JAK-STAT signaling pathway inhibition: a role for treatment of discoid lupus erythematosus and dermatomyositis. Int J Dermatol. 2018 Aug. 57 (8):1007-1014. [QxMD MEDLINE Link].
Solé C, Gimenez-Barcons M, Ferrer B, Ordi-Ros J, Cortés-Hernández J. Microarray study reveals a transforming growth factor-β-dependent mechanism of fibrosis in discoid lupus erythematosus. Br J Dermatol. 2016 Aug. 175 (2):302-13. [QxMD MEDLINE Link].
Solé C, Domingo S, Ferrer B, Moliné T, Ordi-Ros J, Cortés-Hernández J. MicroRNA Expression Profiling Identifies miR-31 and miR-485-3p as Regulators in the Pathogenesis of Discoid Cutaneous Lupus. J Invest Dermatol. 2019 Jan. 139 (1):51-61. [QxMD MEDLINE Link].
Durosaro O, Davis MD, Reed KB, Rohlinger AL. Incidence of cutaneous lupus erythematosus, 1965-2005: a population-based study. Arch Dermatol. 2009 Mar. 145(3):249-53. [QxMD MEDLINE Link].
Jarukitsopa S, Hoganson DD, Crowson CS, Sokumbi O, Davis MD, Michet CJ Jr, et al. Epidemiology of systemic lupus erythematosus and cutaneous lupus erythematosus in a predominantly white population in the United States. Arthritis Care Res (Hoboken). 2015 May. 67 (6):817-28. [QxMD MEDLINE Link].
Drenkard C, Parker S, Aspey LD, Gordon C, Helmick CG, Bao G, et al. Racial Disparities in the Incidence of Primary Chronic Cutaneous Lupus Erythematosus in the Southeastern US: The Georgia Lupus Registry. Arthritis Care Res (Hoboken). 2019 Jan. 71 (1):95-103. [QxMD MEDLINE Link].
Izmirly P, Buyon J, Belmont HM, Sahl S, Wan I, Salmon J, et al. Population-based prevalence and incidence estimates of primary discoid lupus erythematosus from the Manhattan Lupus Surveillance Program. Lupus Sci Med. 2019. 6 (1):e000344. [QxMD MEDLINE Link].
Klein R, Moghadam-Kia S, Taylor L, Coley C, Okawa J, LoMonico J, et al. Quality of life in cutaneous lupus erythematosus. J Am Acad Dermatol. 2011 May. 64 (5):849-58. [QxMD MEDLINE Link].
Achtman J, Kling MA, Feng R, Okawa J, Werth VP. A cross-sectional study of untreated depression and anxiety in cutaneous lupus erythematosus and dermatomyositis. J Am Acad Dermatol. 2016 Feb. 74 (2):377-9. [QxMD MEDLINE Link].
Gordon H, Chandran A, Vandal AC, Yung A, Jarrett P. The relationship between disease severity and quality of life in discoid lupus erythematosus. Br J Dermatol. 2017 Oct. 177 (4):1134-1135. [QxMD MEDLINE Link].
Tao J, Zhang X, Guo N, et al. Squamous cell carcinoma complicating discoid lupus erythematosus in Chinese patients: review of the literature, 1964-2010. J Am Acad Dermatol. 2012 Apr. 66(4):695-6. [QxMD MEDLINE Link].
Zaalberg A, Moradi Tuchayi S, Ameri AH, Ngo KH, Cunningham TJ, Eliane JP, et al. Chronic inflammation promotes skin carcinogenesis in cancer-prone discoid lupus erythematosus. J Invest Dermatol. 2018 Jul 17. [QxMD MEDLINE Link].
Eastham AB, Vleugels RA. Cutaneous lupus erythematosus. JAMA Dermatol. 2014 Mar. 150(3):344. [QxMD MEDLINE Link].
Merola JF, Prystowsky SD, Iversen C, Gomez-Puerta JA, Norton T, Tsao P, et al. Association of discoid lupus erythematosus with other clinical manifestations among patients with systemic lupus erythematosus. J Am Acad Dermatol. 2013 Jul. 69 (1):19-24. [QxMD MEDLINE Link].
Parish LC, Kennedy RJ, Hurley J. Palmar lesions in lupus erythematosus. Arch Dermatol. 1967 Sep. 96(3):273-6. [QxMD MEDLINE Link].
Spann CR, Callen JP, Klein JB, Kulick KB. Clinical, serologic and immunogenetic studies in patients with chronic cutaneous (discoid) lupus erythematosus who have verrucous and/or hypertrophic skin lesions. J Rheumatol. 1988 Feb. 15(2):256-61. [QxMD MEDLINE Link].
Martens PB, Moder KG, Ahmed I. Lupus panniculitis: clinical perspectives from a case series. J Rheumatol. 1999 Jan. 26(1):68-72. [QxMD MEDLINE Link].
Elman SA, Joyce C, Nyberg F, Furukawa F, Goodfield M, Hasegawa M, et al. Development of classification criteria for discoid lupus erythematosus: Results of a Delphi exercise. J Am Acad Dermatol. 2017 Aug. 77 (2):261-267. [QxMD MEDLINE Link].
Biazar C, Sigges J, Patsinakidis N, Ruland V, Amler S, Bonsmann G, et al. Cutaneous lupus erythematosus: first multicenter database analysis of 1002 patients from the European Society of Cutaneous Lupus Erythematosus (EUSCLE). Autoimmun Rev. 2013 Jan. 12 (3):444-54. [QxMD MEDLINE Link].
Kim A, O'Brien J, Tseng LC, Zhang S, Chong BF. Autoantibodies and disease activity in patients with discoid lupus erythematosus. JAMA Dermatol. 2014 Jun. 150 (6):651-4. [QxMD MEDLINE Link].
Jung H, Bobba R, Su J, et al. The protective effect of antimalarial drugs on thrombovascular events in systemic lupus erythematosus. Arthritis Rheum. 2010 Mar. 62(3):863-8. [QxMD MEDLINE Link].
Petri M. Use of hydroxychloroquine to prevent thrombosis in systemic lupus erythematosus and in antiphospholipid antibody-positive patients. Curr Rheumatol Rep. 2011 Feb. 13(1):77-80. [QxMD MEDLINE Link].
Wenzel J, Brähler S, Bauer R, Bieber T, Tüting T. Efficacy and safety of methotrexate in recalcitrant cutaneous lupus erythematosus: results of a retrospective study in 43 patients. Br J Dermatol. 2005 Jul. 153(1):157-62. [QxMD MEDLINE Link].
Callen JP, Spencer LV, Burruss JB, Holtman J. Azathioprine. An effective, corticosteroid-sparing therapy for patients with recalcitrant cutaneous lupus erythematosus or with recalcitrant cutaneous leukocytoclastic vasculitis. Arch Dermatol. 1991 Apr. 127(4):515-22. [QxMD MEDLINE Link].
Nahmias Z, Nambudiri VE, Vleugels RA. Thalidomide and lenalidomide for the treatment of refractory dermatologic conditions. J Am Acad Dermatol. 2016 Jul. 75 (1):210-2. [QxMD MEDLINE Link].
Shah A, Albrecht J, Bonilla-Martinez Z, et al. Lenalidomide for the treatment of resistant discoid lupus erythematosus. Arch Dermatol. 2009 Mar. 145(3):303-6. [QxMD MEDLINE Link]. [Full Text].
Callen JP. Cutaneous lupus erythematosus: a personal approach to management. Australas J Dermatol. 2006 Feb. 47(1):13-27. [QxMD MEDLINE Link].
James JA, Kim-Howard XR, Bruner BF, et al. Hydroxychloroquine sulfate treatment is associated with later onset of systemic lupus erythematosus. Lupus. 2007. 16(6):401-9. [QxMD MEDLINE Link].
Wahie S, Daly AK, Cordell HJ, et al. Clinical and pharmacogenetic influences on response to hydroxychloroquine in discoid lupus erythematosus: a retrospective cohort study. J Invest Dermatol. 2011 Oct. 131(10):1981-6. [QxMD MEDLINE Link].
Marmor MF, Kellner U, Lai TY, Lyons JS, Mieler WF. Revised recommendations on screening for chloroquine and hydroxychloroquine retinopathy. Ophthalmology. 2011 Feb. 118(2):415-22. [QxMD MEDLINE Link].
Chang AY, Werth VP. Treatment of cutaneous lupus. Curr Rheumatol Rep. 2011 Aug. 13 (4):300-7. [QxMD MEDLINE Link].
Mittal L, Zhang L, Feng R, Werth VP. Antimalarial drug toxicities in patients with cutaneous lupus and dermatomyositis: A retrospective cohort study. J Am Acad Dermatol. 2018 Jan. 78 (1):100-106.e1. [QxMD MEDLINE Link].
Alves P, Bashir MM, Wysocka M, Zeidi M, Feng R, Werth VP. Quinacrine Suppresses Tumor Necrosis Factor-α and IFN-α in Dermatomyositis and Cutaneous Lupus Erythematosus. J Investig Dermatol Symp Proc. 2017 Oct. 18 (2):S57-S63. [QxMD MEDLINE Link].
Wahie S, Daly AK, Cordell HJ, et al. Clinical and pharmacogenetic influences on response to hydroxychloroquine in discoid lupus erythematosus: a retrospective cohort study. J Invest Dermatol. 2011 Oct. 131(10):1981-6. [QxMD MEDLINE Link].
Chasset F, Francès C, Barete S, Amoura Z, Arnaud L. Influence of smoking on the efficacy of antimalarials in cutaneous lupus: a meta-analysis of the literature. J Am Acad Dermatol. 2015 Apr. 72 (4):634-9. [QxMD MEDLINE Link].
Gallego H, Crutchfield CE 3rd, Lewis EJ, Gallego HJ. Report of an association between discoid lupus erythematosus and smoking. Cutis. 1999 Apr. 63(4):231-4. [QxMD MEDLINE Link].
Rahman P, Gladman DD, Urowitz MB. Smoking interferes with efficacy of antimalarial therapy in cutaneous lupus. J Rheumatol. 1998 Sep. 25(9):1716-9. [QxMD MEDLINE Link].
Lipsker D, Boeckler P, Hauptmann G. Cigarette smoking and lupus erythematosus. Dermatology. 2006. 212(3):262. [QxMD MEDLINE Link].
Piette EW, Foering KP, Chang AY, et al. Impact of smoking in cutaneous lupus erythematosus. Arch Dermatol. 2012 Mar. 148(3):317-22. [QxMD MEDLINE Link]. [Full Text].
Marmor MF, Kellner U, Lai TY, Melles RB, Mieler WF, American Academy of Ophthalmology. Recommendations on Screening for Chloroquine and Hydroxychloroquine Retinopathy (2016 Revision). Ophthalmology. 2016 Jun. 123 (6):1386-94. [QxMD MEDLINE Link].
Spinelli FR, Moscarelli E, Ceccarelli F, Miranda F, Perricone C, Truglia S, et al. Treating lupus patients with antimalarials: analysis of safety profile in a single-center cohort. Lupus. 2018 Sep. 27 (10):1616-1623. [QxMD MEDLINE Link].
Gammon B, Hansen C, Costner MI. Efficacy of mycophenolate mofetil in antimalarial-resistant cutaneous lupus erythematosus. J Am Acad Dermatol. 2011 Oct. 65(4):717-21. [QxMD MEDLINE Link].
Kreuter A, Tomi NS, Weiner SM, Huger M, Altmeyer P, Gambichler T. Mycophenolate sodium for subacute cutaneous lupus erythematosus resistant to standard therapy. Br J Dermatol. 2007 Jun. 156(6):1321-7. [QxMD MEDLINE Link].
Kindle SA, Wetter DA, Davis MD, Pittelkow MR, Sciallis GF. Lenalidomide treatment of cutaneous lupus erythematosus: the Mayo Clinic experience. Int J Dermatol. 2016 Aug. 55 (8):e431-9. [QxMD MEDLINE Link].
Okon L, Rosenbach M, Krathen M, Rose M, Propert K, Okawa J, et al. Lenalidomide in treatment-refractory cutaneous lupus erythematosus: Efficacy and safety in a 52-week trial. J Am Acad Dermatol. 2014 Mar. 70 (3):583-4. [QxMD MEDLINE Link].
Rosmarin D. Open label phase 2 pilot trial of oral tofactinib in adult subjects with discoid lupus erythematosus (DLE) and systemic lupus erythematosus (SLE). Report No.: NCT03159936. 2017.
De Souza A, Strober BE, Merola JF, Oliver S, Franks AG Jr. Apremilast for discoid lupus erythematosus: results of a phase 2, open-label, single-arm, pilot study. J Drugs Dermatol. 2012 Oct. 11 (10):1224-6. [QxMD MEDLINE Link].
Tenti S, Fabbroni M, Mancini V, Russo F, Galeazzi M, Fioravanti A. Intravenous Immunoglobulins as a new opportunity to treat discoid lupus erythematosus: A case report and review of the literature. Autoimmun Rev. 2018 Aug. 17 (8):791-795. [QxMD MEDLINE Link].
Manzi S, Sánchez-Guerrero J, Merrill JT, Furie R, Gladman D, Navarra SV, et al. Effects of belimumab, a B lymphocyte stimulator-specific inhibitor, on disease activity across multiple organ domains in patients with systemic lupus erythematosus: combined results from two phase III trials. Ann Rheum Dis. 2012 Nov. 71 (11):1833-8. [QxMD MEDLINE Link].
Kuhn A, Landmann A, Wenzel J. Advances in the treatment of cutaneous lupus erythematosus. Lupus. 2016 Jul. 25 (8):830-7. [QxMD MEDLINE Link].
Herold M, Richmond NA, Montuno MA, Wesson SK, Motaparthi K. Rapamycin for refractory discoid lupus erythematosus. Dermatol Ther. 2018 Sep. 31 (5):e12631. [QxMD MEDLINE Link].
Rerknimitr P, Tekacharin N, Panchaprateep R, Wititsuwannakul J, Tangtanatakul P, Hirankarn N, et al. Pulsed-dye laser as an adjuvant treatment for discoid lupus erythematosus: a randomized, controlled trial. J Dermatolog Treat. 2019 Feb. 30 (1):81-86. [QxMD MEDLINE Link].
Erceg A, Bovenschen HJ, van de Kerkhof PC, de Jong EM, Seyger MM. Efficacy and safety of pulsed dye laser treatment for cutaneous discoid lupus erythematosus. J Am Acad Dermatol. 2009 Apr. 60(4):626-32. [QxMD MEDLINE Link].
Callen JP. Management of "refractory" skin disease in patients with lupus erythematosus. Best Pract Res Clin Rheumatol. 2005 Oct. 19(5):767-84. [QxMD MEDLINE Link].
Atra E, Sato EI. Treatment of the cutaneous lesions of systemic lupus erythematosus with thalidomide. Clin Exp Rheumatol. 1993 Sep-Oct. 11(5):487-93. [QxMD MEDLINE Link].
Coelho A, Souto MI, Cardoso CR, et al. Long-term thalidomide use in refractory cutaneous lesions of lupus erythematosus: a 65 series of Brazilian patients. Lupus. 2005. 14(6):434-9. [QxMD MEDLINE Link].
Duong DJ, Spigel GT, Moxley RT 3rd, Gaspari AA. American experience with low-dose thalidomide therapy for severe cutaneous lupus erythematosus. Arch Dermatol. 1999 Sep. 135(9):1079-87. [QxMD MEDLINE Link].
Housman TS, Jorizzo JL, McCarty MA, Grummer SE, Fleischer AB Jr, Sutej PG. Low-dose thalidomide therapy for refractory cutaneous lesions of lupus erythematosus. Arch Dermatol. 2003 Jan. 139(1):50-4. [QxMD MEDLINE Link].
Newton RC, Jorizzo JL, Solomon AR Jr, et al. Mechanism-oriented assessment of isotretinoin in chronic or subacute cutaneous lupus erythematosus. Arch Dermatol. 1986 Feb. 122(2):170-6. [QxMD MEDLINE Link].
Tsianakas A, Herzog S, Landmann A, Patsinakidis N, Perusquía Ortiz AM, Bonsmann G, et al. Successful treatment of discoid lupus erythematosus with fumaric acid esters. J Am Acad Dermatol. 2014 Jul. 71(1):e15-7. [QxMD MEDLINE Link].
Debu A, Girard C, Bessis D. Discoid lupus erythematosus successfully treated by photodynamic therapy. Br J Dermatol. 2014 Sep 12. [QxMD MEDLINE Link].
Turan E, Sinem Bagci I, Turgut Erdemir A, Salih Gurel M. Successful treatment of generalized discoid lupus erythematosus with imiquimod cream 5%: a case report and review of the literature. Acta Dermatovenerol Croat. 2014. 22(2):150-9. [QxMD MEDLINE Link].

Media Gallery

Discoid lupus erythematosus on the face.
Chronic scarred lesion of discoid lupus erythematosus.
Lesions of discoid lupus erythematosus in the conchal bowl demonstrate patulous follicles with follicular plugging.
Palmar lesions of discoid lupus erythematosus.
Scarring alopecia of discoid lupus erythematosus.
Widespread scarring alopecia.
Hypertrophic lesions of chronic cutaneous lupus erythematosus on the dorsal hands. Characteristic lesions were observed elsewhere.

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Author

Ruth Ann Vleugels, MD, MPH Assistant Professor of Dermatology, Harvard Medical School; Associate Physician, Department of Dermatology, Brigham and Women's Hospital; Associate Physician, Department of Immunology and Allergy, Children's Hospital Boston

Ruth Ann Vleugels, MD, MPH is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American College of Rheumatology, American Medical Association, Society for Investigative Dermatology, Medical Dermatology Society, Dermatology Foundation

Disclosure: Nothing to disclose.

Coauthor(s)

Sheena Desai MD Candidate, Tufts University School of Medicine; MBA Candidate, Brandeis University, The Heller School for Social Policy and Management

Sheena Desai is a member of the following medical societies: American Medical Association, Massachusetts Medical Society, Medical Dermatology Society, Skin of Color Society

Disclosure: Nothing to disclose.

Jeffrey P Callen, MD Professor of Medicine (Dermatology), Chief, Division of Dermatology, University of Louisville School of Medicine

Jeffrey P Callen, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American College of Physicians, American College of Rheumatology

Disclosure: Received income in an amount equal to or greater than $250 from: Biogen US (Adjudicator for study entry cutaneous lupus erythematosus); Priovant (Adjudicator for entry into a dermatomyositis study); IQVIA (Serono - adjudicator for a study of cutaneous LE) Received honoraria from UpToDate for author/editor; Received royalty from Elsevier for book author/editor; Received dividends from trust accounts, but I do not control these accounts, and have directed our managers to divest pharmaceutical stocks as is fiscally prudent from Stock holdings in various trust accounts include some pharmaceutical companies and device makers for these trust accounts for: Stocks held in various trust accounts: Allergen; Amgen; Pfizer; 3M; Johnson and Johnson; Merck; Abbott Laboratories; AbbVie; Procter and Gamble;; Celgene; Gilead; CVS; Walgreens; Bristol-Myers Squibb.

Specialty Editor Board

David F Butler, MD Former Section Chief of Dermatology, Central Texas Veterans Healthcare System; Professor of Dermatology, Texas A&M University College of Medicine; Founding Chair, Department of Dermatology, Scott and White Clinic

David F Butler, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, Association of Military Dermatologists, Phi Beta Kappa, Texas Dermatological Society

Disclosure: Nothing to disclose.

Julia R Nunley, MD Professor, Department of Dermatology, Virginia Commonwealth University Medical Center

Julia R Nunley, MD is a member of the following medical societies: American Academy of Dermatology, American College of Physicians, American Society of Nephrology, International Society of Nephrology, Medical Dermatology Society, Medical Society of Virginia, National Kidney Foundation, Phi Beta Kappa, Women's Dermatologic Society

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: American Board of Dermatology Author for: Up-to-date.

Chief Editor

William D James, MD Paul R Gross Professor of Dermatology, Vice-Chairman, Residency Program Director, Department of Dermatology, University of Pennsylvania School of Medicine

William D James, MD is a member of the following medical societies: American Academy of Dermatology, Society for Investigative Dermatology

Disclosure: Received income in an amount equal to or greater than $250 from: Elsevier; WebMD Served as a speaker for various universities, dermatology societies, and dermatology departments.

Additional Contributors

Craig A Elmets, MD Professor and Chair, Department of Dermatology, Director, Chemoprevention Program Director, Comprehensive Cancer Center, UAB Skin Diseases Research Center, University of Alabama at Birmingham School of Medicine

Craig A Elmets, MD is a member of the following medical societies: American Academy of Dermatology, American Association of Immunologists, American College of Physicians, American Federation for Medical Research, Society for Investigative Dermatology

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: University of Alabama at Birmingham; University of Alabama Health Services Foundation Serve(d) as a speaker or a member of a speakers bureau for: Ferndale Laboratories Received research grant from: NIH, Veterans Administration, California Grape Assn Received consulting fee from Astellas for review panel membership; Received salary from Massachusetts Medical Society for employment; Received salary from UpToDate for employment. for: Astellas.

A Brooke W Eastham, MD Board Certified Dermatologist, Nashville Skin and Cancer

A Brooke W Eastham, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, Medical Dermatology Society

Disclosure: Nothing to disclose.

Elizabeth Tkachenko University of Massachusetts Medical School

Disclosure: Nothing to disclose.

Discoid Lupus Erythematosus Medication

Medication Summary

Antimalarial agents

Class Summary

Hydroxychloroquine (Plaquenil)

Chloroquine (Aralen)

Leprostatic agents

Class Summary

Dapsone

Gold compounds

Class Summary

Auranofin (Ridaura)

Immunomodulators

Class Summary

Methotrexate (Rheumatrex, Trexall)

Thalidomide (Thalomid)

Azathioprine (Imuran, Azasan)

Mycophenolate (CellCept, Myfortic)

Corticosteroids

Class Summary

Triamcinolone (Kenalog-10)

Retinoids

Class Summary

Acitretin (Soriatane)

Isotretinoin (Claravis, Sotret, Amnesteem)

References

Tables

Contributor Information and Disclosures

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