This protocol addresses lupus tumidus presenting in the absence of severe or disseminated cutaneous lupus erythematosus (CLE) skin lesions, specifically when prior systemic treatment with methotrexate has not produced adequate improvement in CLE disease activity.
The patient has lupus tumidus with no severe or disseminated cutaneous lupus erythematosus skin lesions — a localised disease picture that nonetheless requires a structured next step in systemic management.
The prior line included methotrexate, preferably in combination with antimalarial drugs (with folic acid supplementation). The target was measurable improvement of CLE disease activity within 3–6 months. When that goal is not met, escalation to this protocol is indicated.
This protocol involves a retinoid-based systemic agent, or an alternative systemic option, preferably used in combination with antimalarial drugs.
The complete regimen — including agent selection, sequencing, and monitoring parameters — is available in the full protocol below.
DOI: 10.1111/ddg.14491
Retinoids are suggested as a second-line systemic treatment for all other forms of CLE.
Dapsone is suggested as second-line therapy for refractory CLE, preferably in combination with antimalarial drugs.
Response usually occurs rapidly within the first 2–6 weeks after treatment initiation.
It is recommended to evaluate the efficacy of systemic treatment for CLE after a minimum of three months and a maximum of six months (except for glucocorticoids).
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