When this therapy is inadequate, other treatments for DLE include azathioprine, retinoids, and dapsone. Recent reports confirm the efficacy of thalidomide for cutaneous lupus erythematosus in dosages ranging from 50 to 200 mg/d.10 Twice-daily application of tacrolimus 0.01% has also been shown to be effective in a few clinical trials.11
Surgery. Surgical intervention is useful to remove scarred lesions, and laser therapy has also been effective, especially for lesions with prominent telangiectasias.12
Patient education. Patient education plays an important role in the treatment of DLE. Advising patients on how to avoid the sun and instructing them in the proper use of sunscreens is extremely important. Smoking cessation has also been shown to be beneficial.13
Patients with DLE generally have a favorable prognosis with regards to morbidity and mortality. Because DLE is usually self-limited, the course is most often benign; therefore, early recognition and adequate therapy may prevent clinical complications. Many patients with DLE go on to develop destructive or deforming scarring or pigmentary disturbances,14 especially in the spring and summer months when the sun is the strongest.
FIGURE 2
After treatment
This patient’s outcome
Our patient was treated with topical fluocinolone acetonide 0.025% ointment and oral hydroxychloroquine 200 mg/d for 1 month. The patient responded well to the treatment and the skin lesion regressed perceptibly (FIGURE 2). The treatment was nevertheless continued for another 5 months, and resulted in complete regression of the lesions, with minimal residual scarring.
CORRESPONDENCE
Amor Khachemoune, MD, CWS, Department of Dermatology, 450 Clarkson Avenue Box 46, Brooklyn, NY 11203. E-mail: amorkh@pol.net