Cochrane Summaries

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Drugs for discoid lupus erythematosus

Jessop S, Whitelaw DA, Delamere FM
Published Online: 
7 October 2009

Discoid lupus erythematosus (DLE) is a severe form of skin inflammation which occurs particularly on sun-exposed skin. It can cause permanent scarring but this can be prevented by early treatment. All forms of cutaneous lupus erythematosus are most common in women of childbearing age: this is particularly important because some treatments, including thalidomide and retinoids, cause birth defects. This review found that fluocinonide cream is more effective than hydrocortisone. Hydroxychloroquine and acitretin appear to work equally well, although acitretin has more frequent and severe adverse effects. Participants taking acitretin showed a small increase in serum triglyceride, not sufficient to require withdrawal of the drug. The acitretin trial was flawed by the inclusion of people with subacute cutaneous lupus and by the lack of a placebo arm. The trial does not provide evidence that either hydroxychloroquine or acitretin will be effective in people not responding to the other agent as it did not use a cross-over design.