Treatments for resistant causes of SCLE

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

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