What are the treatments for resistant causes of SCLE?
• Stop smoking. May impair hydroxychloroquine effect
• Hydroxychloroquine: may take 3 months to see the effect. Works best for tumid LE> SCLE> DLE.
• Glucocorticoids: usually less than 30 mg/day
• Belimumab: takes 4 to 6 months to help skin lesions.
• Bullous lesions: dapsone (measure glucose-6-phosphate dehydrogenase level before starting)
• SCLE: MMF, retinoids, cyclosporine, dapsone
• DLE lesions: hydroxychloroquine ± quinacrine, thalidomide (beware of neuropathy), or cyclosporine. Rituximab does not work well.
• Lupus profundus: dapsone
• Chronic lesions over >50% of body: tacrolimus, MMF, beliumumab
• Vasculitis: may need systemic immunosuppressives
• Hyperkeratotic lesions: oral retinoids
• In trials: apremilast, ustekinumab, Janus kinase (JAK) inhibitors
