Chronic discoid lupus

Alternative/Adjunctive treatment Psoriasis, seborrheic dermatitis, severe diaper rash, dishidrosis, nodular prurigo, chronic discoid lupus erythematosus, alopecia areata, lymphocytic infiltration of the skin, mycosis fungoides, and familial benign pemphigus of Hailey-Hailey. 

Numerous glucocorticosteroids for topical application are available. Essentially they all suppress the symptoms of inflammatory and hypersensitivity reactions and their mechanism of action is similar. Their indications include seborrhoeic and atopic dermatitis, phototoxic reactions, psoriasis, chronic discoid lupus, hypertrophic lichen planus and alopecia areata. However it has to be kept in mind that the use of corticosteroids for these conditions in most cases only gives symptomatic relieve and that the problem tends to recur on cessation of therapy. Traditionally topical corticosteroid formulations are grouped according to approximate relative efficacy. This efficacy is determined by both the potency of the agent and the concentration in which the corticosteroid is used. 

A 41-year-old man with chronic discoid lupus erythematosus was given chloroquine 150 mg bd for 10 days followed by 150 mg/day. After 2 weeks he developed fever, a diffuse papular rash, dyspnea, and sputum. A chest X-ray showed peripheral pulmonary infiltrates. He improved on withdrawal of chloroquine and treatment with cefpiramide and roxithromycin. No organism was isolated. A subsequent oral challenge with chloro-quine provoked a similar reaction. 

UVR can also worsen autoimmune diseases such as chronic discoid lupus erythematosus and subacute and systemic lupus erythematosus, as well as mixed connective tissue diseases and dermatomyositis or other dermatoses, such as rosacea, etc. 

Wozniak KD (1971) Chronic discoid lupus erythematosus as occupational disease in a welder. Dermatosen 19 187-196 Zugerman C (1982) Chromium in welding fiimes. Contact Dermatitis 8 69-70... 

In a series of other dermatoses oral retinoids have been applied with varying clinical efficacy. Etretinate/acitretin were found effective in (i) lichen planus [50] including oral manifestations of lichen mucosae oris with papillomatous and erosive/bullous lesions, (ii) cutaneous variants of lupus erythematosus [11], particularly the hyperkeratotic lesions of chronic-discoid lupus erythematosus, and (iii) lichen sclerosus et atrophicans [7]. Both lichen planus and lichen mucosae oris were also shown to respond to low-dose oral tretinoin. Complete remission was observed in 13/18 patients [65]. The beneficial effect of retinoids in these entities underlines their immunomodulatory dermal action. Prurigo nodularis may be another entity responding well to systemic retinoid therapy. 

Lupus erythematosus For the treatment of chronic discoid and systemic lupus erythematosus (SLE) in patients who have not responded satisfactorily to drugs with less potential for serious side effects. 

A 44-year-old woman received interferon alfa 6 MU/ day for relapse of chronic myeloid leukemia 7 years after successful bone marrow transplantation. About 2 years later, interferon alfa was withdrawn because of diffuse erythematous skin lesions with discoid lupus erythematosus on skin biopsy and severe dysphagia with esophagitis and pseudomembranes at endoscopy. Fever, bilateral pulmonary infiltrates, and respiratory distress syndrome subsequently developed, and she required mechanical ventilation. An open lung biopsy showed features of chronic pulmonary graft-versus-host disease. All her symptoms completely resolved with ciclosporin and corticosteroids. An infectious cause was ruled out. 

Manifestations in the skin are nearly as common as those involving the musculoskeletal system. " The most well known of these is the butterfly rash, which occurs over the bridge of the nose and the malar eminences. The classic butterfly rash is seen in approximately one-half of patients and often is observed after sun exposure. In fact, photosensitivity is common to many SLE patients who present with cutaneous manifestations. Skin lesions characteristic of discoid lupus occur in 10% to 20% of patients with SLE and may occur without other clinical or serologic evidence of lupus. Some individuals are said to develop subacute cutaneous lupus erythematosus, the nature of whose lesions falls between discoid (one type of chronic... 

Hydroxychloroquine sulfate is a 4-aminoquinoline compound that interferes with parasitic nucleoprotein (DNA/ RNA) synthesis and parasite growth or causes lysis of parasite or infected erythrocytes. In rheumatoid arthritis, it may suppress formation of antigens responsible for symptom-producing hypersensitivity reactions. It is indicated for prophylaxis and treatment of acute attacks of malaria caused by Plasmodium vivax, Plasmodium malariae, and Plasmodium ovale, and susceptible strains of Plasmodium falciparum. It is also used for treatment of chronic discoid and systemic lupus erythematosus (SLE) and acute or chronic rheumatoid arthritis in patients not responding to other therapies. 

Chloroquine or its analogs are used to treat hepatic amebiasis and are secondary drugs for variety of chronic inflammatory diseases, including rheumatoid arthritis, systemic lupus erythematosus, discoid lupus, sarcoidosis, and photosensitivity diseases such as porphyria cutanea tarda. 

Use of this drug in other flelds, including chronic hepatopathy, in which it is claimed to improve hepatic function, has been reported. When employing it for this purpose, Dohrmann et al. (29 ) found that flush reactions or skin allergy occurred in some 2% of cases. Szabolcsi in Hungary has described a patient with discoid lupus erythematodes in whom a severe toxicoderma developed after 4 weeks of treatment with xanthinol nico-... 

Chloroquine and hydroxychloroquine are quinoline drugs used for the chronic management of rheumatoid arthritis, discoid and systemic lupus erythematosus, and other collagen diseases. Because chloroquine is rapidly absorbed and becomes highly concentrated in various tissues due to melanin and protein binding, it is now used only for malaria prophylaxis. Hydroxychloroquine has replaced it primarily because of its superior safety profile. 

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