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Evidence summaries

Drugs for Discoid Lupus Erythematosus

Fluocinonide cream might possibly be more effective than hydrocortisone cream for discoid lupus erythematosus, although the evidence is insufficient. Hydroxychloroquine and acitretin may be as effective although adverse effects might be more frequent with acitretin. Level of evidence: "D"

The quality of evidence is downgraded by study limitations (unclear allocation concealment), by indirectness (differences between the outcomes of interest and those reported: only short-term outcomes reported), and by imprecise results (few patients and outcome events).

Summary

A Cochrane review [Abstract] 1 included 5 studies with a total of 197 subjects. Interventions in the 5 studies were topical steroids, hydroxychloroquine, acitretin, topical salbutamol, topical tacrolimus, and topical pimecrolimus. Complete resolution of skin lesions was seen in 27% of people using fluocinonide 0.05% cream and in 10% of those using 1% hydrocortisone cream in one 6-week study (RR 2.77, 95% CI 0.95 to 8.08; 1 study, n=78).

In a study comparing acitretin 50 mg daily and hydroxychloroquine 400 mg daily in 58 people, there was complete resolution in 46% of people using acitretin and in 50% of people using hydroxychloroquine (RR 0.93, 95% CI 0.54 to 1.59). Clearing of erythema in at least 50% of lesions was reported in 42% on acitretin and 68% on hydroxychloroquine (RR 0.61, 95% CI 0.36 to 1.06, 1 study, n=49). The main adverse effects were dry lips (93% of the acitretin group and 20% of the hydroxychloroquine group) and gastrointestinal disturbance (11% of the acitretin group and 17% of the hydroxychloroquine group). Four participants on acitretin withdrew due to gastrointestinal events or dry lips.

One study (n=10) compared a calcineurin inhibitor, pimecrolimus 1% cream and betamethasone 17-valerate 0.1% cream, and another study (n=14) compared tacrolimus cream 0.1% with placebo (vehicle), but these studies reported none of the primary outcome measures.Topical R-salbutamol 0.5% cream was compared with placebo (vehicle) over 8 weeks in one study (n=37). There was a significant improvement in pain and itch in the salbutamol group at 2, 4, 6, and 8 weeks compared to placebo, but the study did not record a formal measure of quality of life. None of the primary outcome measures were reported.

    References

    • Jessop S, Whitelaw DA, Grainge MJ et al. Drugs for discoid lupus erythematosus. Cochrane Database Syst Rev 2017;(5):CD002954. [PubMed].

Primary/Secondary Keywords