Resistant discoid lupus erythematosus of palms and soles: Successful treatment with azathioprine

Cutaneous lupus erythematosus encompasses a wide range of dermatologic manifestations, which may or may not be associated with the development of systemic disease. Cutaneous lupus is divided into several subtypes, including acute cutaneous lupus erythematosus, subacute cutaneous lupus erythematosus, and chronic cutaneous lupus erythematosus. Chronic cutaneous lupus erythematosus includes discoid lupus erythematosus, lupus erythematosus profundus, chilblain cutaneous lupus, and lupus tumidus. Diagnosis of these diseases requires proper classification of the subtype, through a combination of physical exam, laboratory studies, histology, antibody serology, and occasionally direct immunofluorescence, while ensuring to exclude systemic disease. Treatment of cutaneous lupus consists of patient education on proper sun protection along with appropriate topical and systemic agents. Systemic agents are indicated in cases of widespread, scarring, or treatment-refractory disease. In this review, we discuss issues in classification and diagnosis of the various subtypes of CLE, as well as provide an update on therapeutic management.

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“…Another suggested treatment option is azathioprine, which was shown to successfully treat DLE in several small case series [75-77]. …”

Section: E How Is Cle Treatment Approached?mentioning

confidence: 99%

Cutaneous lupus erythematosus: Diagnosis and treatment

Okon¹,

Werth²

2013

Best Practice & Research Clinical Rheumatology

255

257

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“…Mycophenolate sodium, which is enteric-coated, has been associated with fewer gastrointestinal side effects. Azathioprine can also be effective in DLE [38]. When starting azathioprine, a low dose of 50mg a day is used initially and increased by 25mg every two weeks, as laboratory monitoring allows, until the minimum effective dose is achieved.…”

Section: Systemic Therapiesmentioning

confidence: 99%

Treatment of Cutaneous Lupus

Chang

Werth

2011

Curr Rheumatol Rep

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Cutaneous lupus erythematosus (CLE) is an autoimmune, inflammatory skin disease seen in patients with or without systemic lupus erythematosus (SLE). The management of CLE includes treatment and prevention of lesions, as well as routine assessment for systemic disease. Treatment options include both topical and systemic therapies. Topical therapies include corticosteroids and calcineurin inhibitors. Systemic therapies generally fall under one of three categories: antimalarials, immunomodulators, such as dapsone and thalidomide, and immunosuppressives, such as methotrexate and mycophenolate. Evidence for the treatment of CLE is limited by few prospective studies, as well as lack of a validated outcome measure up until recently. There is good evidence to support the use of topical steroids and calcineurin inhibitors, though most of these trials have not used placebo or vehicle controls. There have been no randomized placebo-controlled trials evaluating systemic therapies for the treatment of CLE.

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“…152 Other uses Azathioprine has been reported to be successful not only in immunobullous, photodermatotic, and eczematous diseases but also in a number of other severe or recalcitrant conditions. As shown in Table V, azathioprine has been used to treat Behçet syndrome, 153,154 pityriasis rubra pilaris, 155 erythema multiforme, [156][157][158] lichen planus, [159][160][161] vasculitis, [162][163][164][165][166][167] cutaneous lupus, 163,[168][169][170] Reiter syndrome, 171 graftversus-host disease, 172,173 prurigo nodularis, 174 Sulzberger and Garbe, 175 and acne fulminans. 176 The evidence for Behçet syndrome is encouraging, and early treatment with azathioprine has been shown to favorably affect the long-term prognosis of the disease.…”

Section: Photodermatosesmentioning

confidence: 99%