This protocol addresses patients with lupus tumidus presenting with severe or disseminated cutaneous lupus erythematosus (CLE) skin lesions whose condition has not adequately improved following a complete first-line treatment course.
The prior regimen included topical glucocorticoids (class 2–4), or topical tacrolimus, or topical pimecrolimus, combined with hydroxychloroquine or chloroquine, and a tapering course of prednisolone.
Escalation to this protocol is indicated when no adequate improvement of cutaneous lupus erythematosus skin lesions is observed after 16 weeks of that regimen.
Treatment goals: Improvement of skin lesions within 3–4 weeks; maximum effects expected after 6–8 weeks.
Antimalarial drugs are recommended as first-line treatments, also for long-term therapy, in all CLE patients with severe and disseminated skin lesions; in particular for patients with a risk of scarring.
For severe or disseminated CLE lesions, systemic glucocorticoids are recommended as first-line treatment in addition to antimalarial drugs, for a limited period of time.
In treatment refractory cases, or in cases of intolerance or retinopathy, systemic treatment with mepacrine is suggested either instead of or in combination with HCQ or CQ.
Mepacrine is usually combined with CQ/HCQ since it acts synergistically with these drugs and does not increase the risk of retinopathy.
Skin lesions will improve within three to four weeks; maximum effects are seen after six to eight weeks.
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