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Treatment of cutaneous lupus erythematosus with acitretin and hydroxychloroquine
T Ruzicka1, C Sommerburg, G Goerz
1Department of Dermatology, University of München, Germany.
Insights
This study compared acitretin and hydroxychloroquine for cutaneous lupus erythematosus (LE). Both treatments showed similar efficacy, improving about 50% of facial LE lesions, but acitretin had more side effects.
Area of Science:
- Dermatology
- Rheumatology
- Clinical Pharmacology
Background:
- Cutaneous lupus erythematosus (LE) presents a therapeutic challenge.
- Limited data exists comparing systemic treatments for facial LE lesions.
Purpose of the Study:
- To compare the efficacy and safety of acitretin versus hydroxychloroquine in treating cutaneous LE.
- To evaluate the impact of these treatments on specific LE lesion characteristics.
Main Methods:
- A randomized, double-blind, multicenter study.
- 28 patients received acitretin (50 mg/day), 30 received hydroxychloroquine (400 mg/day) for 8 weeks.
- Clinical parameters assessed facial LE lesion improvement (erythema, infiltration, scaling/hyperkeratosis).
Main Results:
- Overall improvement: 46% with acitretin, 50% with hydroxychloroquine.
- Hydroxychloroquine showed higher response rates for erythema (68%) and infiltration (68%) compared to acitretin (42% and 63%, respectively).
- Acitretin group experienced a higher incidence of side-effects, leading to treatment discontinuation in four patients.
Conclusions:
- Both acitretin and hydroxychloroquine are effective treatments for cutaneous LE, with approximately 50% of patients showing improvement.
- Hydroxychloroquine may offer superior efficacy for certain facial LE lesion types.
- Acitretin is associated with a higher rate of adverse events requiring treatment cessation.
Abstract:
A randomized, double-blind, multicentre study was performed to compare the efficacy of acitretin (50 mg/day) with hydroxychloroquine (400 mg/day) in 28 and 30 patients, respectively, suffering from cutaneous lupus erythematosus (LE). The study was carried out over an 8-week period. Improvement of facial LE lesions after treatment with acitretin and hydroxychloroquine was assessed using several clinical parameters. In the acitretin group there was marked improvement or clearing of erythema in 10/24 patients (42%), of infiltration in 15/24 (63%) and of scaling/hyperkeratosis in 12/20 (60%). In the hydroxychloroquine group there was complete clearing or marked improvement of erythema in 17/25 patients (68%), of infiltration in 17/25 (68%) and of scaling/hyperkeratosis in 15/23 (65%). Overall improvement occurred in 13/28 patients (46%) treated with acitretin and in 15/30 patients (50%) with hydroxychloroquine. The incidence of side-effects was higher in the acitretin group, and necessitated discontinuation of treatment in four patients. The present results demonstrate that both acitretin and hydroxychloroquine provide effective treatment in approximately 50% of cases of cutaneous LE.