Treatment of discoid lupus erythematosus with crisaborole

Discoid lupus erythematosus (DLE) is a chronic autoimmune skin disorder that primarily affects sun-exposed areas and may lead to permanent scarring and dyspigmentation if inadequately treated. Therapeutic options for DLE remain limited, and long-term use of topical corticosteroids or calcineurin inhibitors is often constrained by adverse effects, particularly on facial skin. This report aims to describe the clinical response of facial DLE to topical crisaborole treatment.

We report the case of a 20-year-old woman with a 7-year history of a persistent erythematous plaque on the nose, previously misdiagnosed and refractory to multiple treatments, including systemic antimalarials and topical agents. Histopathological examination and direct immunofluorescence findings supported a diagnosis of DLE without systemic involvement. The patient was treated with topical crisaborole 2% ointment once daily in combination with hydroxychloroquine.

Marked clinical improvement was observed after two months of treatment. Sustained remission was maintained during a seven-month follow-up period with continued crisaborole use and dose reduction of hydroxychloroquine, without recurrence or adverse effects.

Crisaborole, a topical phosphodiesterase-4 inhibitor approved for atopic dermatitis, may represent a well-tolerated nonsteroidal therapeutic option for facial DLE, particularly in patients who are unresponsive to or intolerant of conventional treatments. Further studies are needed to clarify its efficacy and long-term safety in DLE.