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Drugs for discoid lupus erythematosusJessop S, Whitelaw D, Jordaan F
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SummaryHigh potency steroid cream may be more effective for DLE than low potency steroid cream but may have long term adverse effectsDiscoid lupus erythematosus (DLE) is a severe form of skin inflammation which occurs particularly on sun-exposed skin. It can cause permanent scarring but this can be prevented by early treatment. All forms of DLE are common in women of childbearing age: this is particularly important because some treatments, including thalidomide and retinoids, cause birth defects. The review found that fluocinoinide cream is more effective than hydrocortisone. Hydroxychloroquine and acitretin appear to work equally well, although acitretin has more frequent and severe adverse effects. More research is needed to establish the best and safest treatment for DLE.
This is a Cochrane review abstract and plain language summary, prepared and maintained by The Cochrane Collaboration, currently published in The Cochrane Database of Systematic Reviews 2008 Issue 3, Copyright © 2008 The Cochrane Collaboration. Published by John Wiley and Sons, Ltd.. The full text of the review is available in The Cochrane Library (ISSN 1464-780X).
This version first published online:
January 22. 2001 AbstractBackgroundDiscoid lupus erythematosus is a chronic form of cutaneous (skin) lupus which can cause permanent scarring if treatment is inadequate. Many drugs have been used to treat this disease and some of these are potentially very toxic. ObjectivesTo assess the effects of drugs for discoid lupus erythematosus. Search strategyWe searched the Cochrane Clinical Trials Register (December 1999), MEDLINE (January 1966 to December 1999), EMBASE (January 1980 to January 2000), and the reference lists of relevant reviews. Index Medicus (1956 to 1966) was handsearched and 7 experts in the field were approached for information about unpublished trials. Selection criteriaRandomised trials of drugs to treat people with discoid lupus erythematosus. Drugs included in the search were azathioprine, chloroquine, clofazimine, corticosteroids, (oral and topical), dapsone, gold, interferon alpha-2a, methotrexate, phenytoin, retinoids, sulphasalazine and thalidomide. Data collection and analysisTwo reviewers independently examined each retrieved study for eligibility. Main resultsTwo trials involving 136 participants were included. In a cross-over study of twelve weeks duration fluocinonide 0.05% cream (a potent topical corticosteroid), appeared to be markedly better than hydrocortisone 1% cream ( a mild corticosteroid). Clearing or excellent improvement was seen in 27% of people using fluocinonide and in 10% of those using hydrocortisone, giving a 17% absolute benefit in favour of fluocinonide (95% CI 4.5 to 29.5% and NNT 6). In the second trial, hydroxychloroquine was compared with acitretin in 58 people. There was marked improvement or clearing in 46% of people using acitretin and in 50% of those on hydroxychloroquine, a nonsignificant 4% absolute gain with hydroxychloroquine (95%CI -23% to 30%). The adverse effects were more frequent and more severe in the acitretin group. Authors' conclusionsFluocinonide cream may be more effective than hydrocortisone in treating people with discoid lupus erythematosus. Hydroxychloroquine and acitretin appear to be of equal efficacy, although adverse effects are more frequent and more severe with acitretin. There is not enough reliable evidence about other drugs used to treat discoid lupus erythematosus. |
