Treatment of cutaneous lupus erythematosus with acitretin and hydroxychloroquine

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.     

Varied responses to and efficacies of hydroxychloroquine treatment according to cutaneous lupus erythematosus subtypes in Japanese patients

Hydroxychloroquine is recommended as the first‐line systemic treatment for cutaneous lupus erythematosus (CLE) in Western countries, and it was approved in Japan in 2016. However, the efficacy of hydroxychloroquine in various cutaneous lupus erythematosus subtypes in Japanese patients has not been elucidated to date. Therefore, we investigated the efficacy of hydroxychloroquine for the treatment of cutaneous manifestations according to CLE subtypes in Japanese patients. We enrolled 35 patients (29 diagnosed with systemic lupus erythematosus and six with CLE) in this retrospective study. We analyzed the efficacy of hydroxychloroquine for the treatment of cutaneous manifestations according to cutaneous lupus erythematosus subtypes, time to the first skin improvement, as well as effects on laboratory data and reduction of concomitant immunosuppressive drug administration at 16 and 32 weeks of therapy. Complete improvement was observed at high rates for acute CLE (ACLE); however, partial or non‐improvement rates were higher for chronic CLE (CCLE) at 16 weeks. Several patients with alopecia without scarring achieved complete improvement at 32 weeks. CCLE tended to take more time to improve than ACLE. Overall, hydroxychloroquine was highly effective for skin: 87% of patients had at least some beneficial response at 16 weeks. Nevertheless, there were wide variations in complete improvement rates and duration for improvement among CLE subtypes. Our findings suggest that a therapeutic approach considering the subtypes of CLE will improve its management.     

Plasmacytoid dendritic cells are present in cutaneous dermatomyositis lesions in a pattern distinct from lupus erythematosus

Background:  Plasmacytoid dendritic cells (PDCs) are CD123-positive dendritic cells (DCs) capable of producing interferon-α (IFN). They are thought to play a role in anti-viral immunity and the pathogenesis of lupus erythematosus (LE). Given the histologic similarities between LE and dermatomyositis (DM), we evaluated the presence and distribution of PDCs in lesional skin of both diseases.
Methods:  Twenty-eight biopsies of DM and 27 biopsies of LE were labeled with antibodies to CD123 to identify PDCs. The presence and relative distribution of CD123+ cells was recorded.
Results:  PDCs are present in LE and DM, albeit in greater numbers in LE lesions. Interestingly, PDCs are preferentially located in the epidermis of DM, and are primarily located in the dermis of LE.
Conclusions:  Skin lesions of DM contain PDCs. Because PDCs are thought to participate in the pathogenesis of LE, this finding suggests that they may play a role in DM as well. The preferential epidermal localization of PDCs in DM suggests that their contribution to disease pathogenesis or maintenance in DM may be distinct from LE. Finally, although not pathognomonic, the different patterns of PDC localization in LE and DM may prove a helpful criterion for distinguishing between these two entities histologically.     

Effectiveness of topical calcineurin inhibitors as monotherapy or in combination with hydroxychloroquine in cutaneous lupus erythematosus

Background Calcineurin inhibitors show potent anti‐inflammatory effects and favorable safety profile when used in the treatment of cutaneous lupus erythematosus (CLE). Objective The present study investigates the change in clinical parameters of erythema, desquamation and edema, when calcineurin inhibitors are used as monotherapy or in combination with hydroxychloroquine in CLE for a period of 60 days. Methods 18 patients were treated with topical tacrolimus and 20 patients with topical pimecrolimus, as monotherapy or in combination with hydroxychloroquine. Clinical parameters of erythema, desquamation and edema were assessed on a scale from 0 to 3 for erythema and edema and 0 to 2 for desquamation. Results Statistically significant improvement in erythema, desquamation and edema was observed in patients on monotherapy with calcineurin inhibitor and combination treatment with hydroxychloroquine, regardless of disease type. Combination treatment resulted in improvement of edema in 100% of patients, while monotherapy did so in 75% of patients. Conclusions Topical calcineurin inhibitors enhance the therapeutic effect of systemic agents in cutaneous lupus erythematosus, and result in improvement of the clinical parameters studied.     

Hydroxychloroquine and smoking in patients with cutaneous lupus erythematosus

Antimalarials, such as chloroquine and hydroxychloroquine, have been used to treat cutaneous and systemic lupus erythematosus for decades with excellent therapeutic efficacy. Smoking seems to inhibit the therapeutic efficacy of antimalarials when treating cutaneous lupus erythematosus (CLE), but the reason behind this observation is unclear. In addition, antimalarials have been associated with several potentially serious adverse effects, including irreversible loss of vision. The aim of this literature review is to discuss the evidence for how cigarette smoking interferes with antimalarial efficacy in the treatment of CLE. Evidence-based data with long-term follow-up will allow determination of the aetiology for diminished antimalarial response, and enable selection of the best treatment to maximize long-term remission in CLE.     

Treatment of cutaneous lesions in patients with lupus erythematosus

After proper classification of cutaneous lesions in LE patients and extensive evaluation, we can begin to approach effective therapy. Patients with cutaneous lupus erythematosus (discoid LE or subacute cutaneous LE) generally have a favorable prognosis and can be managed with safe yet effective therapy. Sunscreens are the most important topical therapy. Intralesional corticosteroids are an effective local adjunctive therapy, useful in bringing lesions under control. Systemic therapy with antimalarials, either used singly or in combination, are usually effective. When "standard" therapy fails, azathioprine, retinoids, or occasionally dapsone may be effective.     

Adverse cutaneous reactions to erlotinib

IntroductionErlotinib is an inhibitor of human epidermal growth factor approved for treating non-small cell lung cancer. The aim of this prospective observational study was to determine the prevalence of adverse cutaneous reactions caused by erlotinib and assess the management of such effects.MethodsEleven patients with lung cancer and 1 with ovarian cancer received erlotinib at a dose of 150 mg/d. The prevalence, severity, and time course of the adverse cutaneous reactions were assessed.ResultsThe most frequent cutaneous reaction was acneiform eruption (10 cases). The patients were treated with topical erythromycin and clindamycin, or with doxycycline. Also reported were seborrheic dermatitis (5), paronychia (4), xerosis (3), mouth blisters (3), blepharitis (2), cheilitis (1), and fissures on the hands and feet (1). The first reactions to appear were seborrheic dermatitis (9.8 days until onset) and acneiform eruption (11.8 days), whereas the paronychia presented latest (65.3 days). One patient with acneiform eruption and another with paronychia suspended treatment until the lesions improved.ConclusionsErlotinib induces adverse effects in most patients treated. Acneiform eruption, seborrheic dermatitis, and paronychia are the most frequently reported reactions and can lead to temporary suspension of erlotinib administration.     

Adverse cutaneous reactions to antidepressants

Antidepressants are among the most widely prescribed medications in the United States. Adverse cutaneous drug reactions (ACDRs) associated with drugs are common, with possibly higher rates associated with psychotropic medications. While the vast majority of ACDRs are benign and easily treated, serious and life- threatening ACDRs, such as those associated with antidepressants, do rarely occur. ACDRs to antidepressants are diagnosed primarily on the basis of the patient's history. A clinician who is aware of these common and potentially serious adverse events will help avoid their continuation or recurrence. There are certain characteristics that place an individual at higher risk for an ACDR such as female gender, increasing age, African-American ethnicity, use of multiple medications and presence of a serious illness. If a cutaneous reaction occurs in an outpatient setting, it is advisable to discontinue the offending antidepressant and substitute it with one from another class. Treatment of the ACDR should be symptomatic if the patient shows no other significant signs of reaction. If other signs are present, however, a dermatology consultation should be obtained. Since the diagnosis of ACDRs is often tentative, and the exanthema is likely to be benign, the physician treating a patient with a mood or anxiety disorder must weigh the risk of developing these potential problems against the possibility of relapse of the psychiatric disorder should the medication be discontinued.     

Adverse cutaneous reactions to antipsychotics

Antipsychotic agents are known to cause adverse cutaneous reactions in approximately 5% of the individuals for whom they are prescribed. The majority of adverse cutaneous events are benign and easily treated, and do not place the patient at a serious health risk. However, these adverse events may impact on compliance so discussing strategies with the patient to avoid potential adverse cutaneous effects will improve compliance. The most frequently reported cutaneous adverse effects of antipsychotic medications include: exanthematous eruptions, skin pigmentation changes, photosensitivity, urticaria and pruritus. Only a small percentage of adverse cutaneous reactions are life threatening. The most important step in minimizing morbidity is prompt recognition of severe drug reactions with withdrawal of the causative medication. If a skin eruption occurs in an outpatient setting, it is generally advisable to discontinue the drug and to consider switching to another class of agent. If the reaction is mild, and the therapeutic benefits far exceed the risks of the symptomatic treatment, then the antipsychotic agent may be continued.     

皮肌炎,SLE患者的甲状腺激素测定

对１９例皮肌炎和６１例系统性约斑狼疮患者的甲状腺激素水平进行了测定。结果显示：患者的Ｔ３、Ｔ４、ｒＴ３值均明显低于正常组（Ｐ〈０．０１），ＴＳＨ值在正常规范（Ｐ〉０．０５）。作者认为Ｔ３的降低与病情轻重有关，吸助于对疾病转归的估价；Ｔ３、Ｔ４降低与疙瘩预后有关，对随访变有重要意义。