Discoid lupus erythematosus, treatment

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. 

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... 

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. 

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. 

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

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. ... 

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. 

Hydroxychloroquine (Plaquenil), like chloroquine, is a 4-aminoquinoline derivative used for the suppressive and acute treatment of malaria. It also has been used for rheumatoid arthritis and discoid and systemic lupus erythematosus. Hydroxychloroquine has not been proved to be more effective than chloroquine. Adverse reactions associated with its use are similar to those described for chloroquine. The drug should not be used in patients with psoriasis or porphyria, since it may exacerbate these conditions. 

Lupus er/thennatosus (affecting tlic skin) Photoprotection is essential. Potent adrenal steroid topically or intralesionally. Hydroxychloroquine or mepacrine. Monitor for retinal toxicity when treatment is long-term.Other agents include auranofin, aceiretin and in severe chilblain LE. thalidomide. A systemic disease, but discoid iupus erythematosus typicaily has no systemic manifestations. 

Although patients treated with etanercept commonly develop new antinuclear antibodies or anti-double-stranded DNA antibodies, there were no reports of cutaneous or systemic lupus erythematosus in early clinical trials. However, since then, at least eight cases have been reported, including five patients with a lupus-like syndrome, two with acute discoid lupus, and one with subacute cutaneous lupus erythematosus (26-29). All were women and they developed their first symptoms 6 weeks to 14 months after the first injection of etanercept. Antinuclear and/or anti-DNA antibodies were positive in most of them. Etanercept was withdrawn in all patients with features of systemic lupus erythematosus, and the symptoms resolved within 2-8 weeks. The skin lesions also improved with local glucocorticoids, despite continued etanercept treatment in two patients with discoid lupus or subacute cutaneous lupus erythematosus. This suggests that etanercept-induced autoantibodies are sometimes associated with clinical autoimmune disease. 

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. 

THERAPEUTIC USES FDA-approved dermatological uses of hydroxychloroquine include treatment of discoid and systemic lupus erythematosus. Unapproved but first-line uses include treatment of dermatomyositis, porphyria cutanea tarda, polymorphous light eruption, sarcoidosis, eosinophilic fasciitis, lymphocytic infiltrate of Jessner, lymphocytoma cutis, solar urticaria, granuloma annulare, and some forms of panniculitis. 

Monovalent organogold salts have been used, with mixed results, in the treatment of pemphigus (skin and mucous membrane blisters), lupus erythematosus, ulcerative colitis, Crohn s disease, various types of arthritis, bronchial asthma, bullous skin conditions, discoid lupus, several forms of rheumatism, ankylosing spondylitis affecting peripheral joints, kala-azar (caused by the flagellate protozoan Leishmania donovani... 

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