This protocol covers patients presenting with severe or widespread skin lesions of discoid lupus erythematosus, including those at risk of scarring or progression to systemic disease, who are not pregnant and not breastfeeding.
Antimalarials are recommended as first-line and long-term systemic treatment in patients with severe or widespread lesions, particularly those at risk of scarring or development of systemic disease. In severe or widespread active lesions, systemic corticosteroids are also recommended as a first-line addition to antimalarial therapy.
The regimen involves quinacrine — used either in combination with an established antimalarial agent, or as primary antimalarial therapy in cases where standard antimalarials are contraindicated.
We recommend antimalarials as first-line and long-term systemic treatment in all CLE patients with severe or widespread skin lesions, in particular in patients with the risk of scarring and development of systemic disease.
In severe or widespread active CLE lesions, systemic corticosteroids are recommended as first-line treatment in addition to antimalarials.
In refractory cases, we recommend to add quinacrine to either HCQ or CQ.
In cases of contraindication for HCQ or CQ (e.g., retinopathy), monotherapy with quinacrine is recommended.
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