Treatment of refractory cutaneous lupus erythematosus

Photoprotection, topical steroids, and hydroxychloroquine are the mainstays of therapy of cutaneous LE. In severe and/or refractory disease, antimalarials remain the drugs of choice, and multiple induction and combination strategies can be employed to achieve optimal results with minimal toxicity. Retinoids, dapsone, clofazimine, and thalidomide are effective but more toxic alternatives. Their use dictates frequent and careful monitoring. Retinoids and thalidomide are teratogenic, and thalidomide is not available in the United States. Results with vitamin E are controversial. Gold and IFN-alpha have unacceptably high risk to benefit ratios. Cytotoxic agents are generally restricted to the patients with concomitant organ-threatening systemic disease.