Discoid lupus erythematosus

Discoid lupus erythematosus discoid patches with adherent thick scales and follicular plugging, atrophic scarring... 

DL-CFU Dendritic cell/Langerhans cell colony forming DLE Discoid lupus erythematosus DMARD Disease-modifying antirheumatic drug... 

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. 

Atopic dermatitis, contact dermatitis, dermatitis, discoid lupus erythematosus, eczema, exfoliative dermatitis, granuloma annulare, lichen planus, lichen simplex, polymorphous light eruption, pruritus, psoriasis, Rhus dermatitis, seborrheic dermatitis, xerosis ... 

Unlabeled Uses Prevention and treatment of discoid lupus erythematosus, erythema multiforme, graft vs host reactions following bone marrow transplantation, rheumatoid arthritis treatment of Behget s syndrome, Crohn s disease, G1 bleeding, multiple myeloma, pruritus, recurrent aphthous ulcers in HIV patients, wasting syndrome associated with HIV or cancer... 

Dermatology Topical steroids are useful in keloids, hypertrophic scars, other localised hypertrophic, infiltrated, inflammatory lesions of lichen planus, psoriatic plaques, granuloma annulare and lichen simplex chronicus discoid lupus erythematosus, necrobiosis lipoidica diabeticorum and alopecia areata. 

Antimicrobial spectrum Chloroquine is the drug of choice in the treatment of erythrocytic falciparum malaria, except in resistant strains. Chloroquine is less effective against vivax malaria. It is highly specific for the asexual form of R vivax and R falciparum. It is also effective in the treatment of extraintestinal amebiasis (see p. 346). The anti-inflammatory action of chloroquine explains its occasional use in rheumatoid arthritis and discoid lupus erythematosus. 

Adrenal steroids of highest potency are reserved for recalcitrant dermatoses, e.g. lichen simplex, lichen planus, nodular prurigo and discoid lupus erythematosus. 

Choice of preparation relates both to the disease and the site of intended use. High potency preparations are commonly needed for lichen planus and discoid lupus erythematosus weaker preparations (hydrocortisone 0,5-2.5%) are usually adequate for eczema, use on the face and in childhood. 

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. 

Other types of skin reactions that have been described in isolated reports include urticaria-like eruptions with prurigo in two patients with juvenile arthritis (23) and discoid lupus erythematosus in a woman with rheumatoid arthritis (21). Erythema multiforme in three patients and a lichenoid eruption in one were attributed to infliximab however, one patient had similar lesions after etanercept (24). 

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. 

Two young women with discoid lupus erythematosus developed amenorrhea after taking thalidomide 100-150 mg/day (86). In one patient the menstrual cycle returned to normal within 5 months after withdrawal of thalidomide in another the dosage was reduced to 50 mg on alternate days but menstruation had not returned 6 months later. 

SLE, Systemic lupus erythematosus (or SLE-lilce disease) DLE, discoid lupus erythematosus GN, glomerulonephritis. Both quantitative and quahtative (functional) deficiencies reported. 

Chloroquine also is prescribed for treatment of rheumatoid arthritis, discoid lupus erythematosus, and photosensitivity diseases. 

Other dmg-induced dermatitis includes discoid lupus erythematosus (DLE) and exfoliative dermatitis. Hydralazine hydrochloride (Apresoline), isoniazid (INH), phenothiazines, anticonvulsants, and antidysrhythmics such as procainamide (Pronestyl) may cause lupus-like symptoms. If lupus-like symptoms occur, the drug should be discontinued. 

Gold drugs have been used to treat a variety of other rheumatic diseases including psoriatic arthritis , a form of arthritis associated with psoriasis, juvenile arthritis, palindromic rheumatism and discoid lupus erythematosus . Gold therapy has also been investigated as a treatment for various inflammatory skin disorders such as psoriasis, pemphigus and urticaria. ... 

Actinic reticuloid Tinea versicolor Pityriasis alba Postinflammatory eczematous dermatitis, discoid lupus, erythematosus, psoriasis... 

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... 

Cemil BC, Atas H, Canpolat F, Akca Y, Sasmaz R. Infliximab-induced discoid lupus erythematosus. Lupus 2013 22(5) 515-8. 

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. 

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