Different Drugs Used in the Treatment of Discoid Lupus Erythematosus
| Name of Drug | Dose | Adverse Effects | Remarks |
|---|---|---|---|
| Topical and intralesional steroids | Start with potent topical preparation, strength of intradermal triamcinolone 3 to 5 mg/mL | Cutaneous atrophy, telengiectasiae, striae, and purpura with topical steroids; atrophy and dyspigmentation with intralesional steroids | Side effects from systemic absorption insignificant with topical steroids but can occur with intralesional steroids |
| Antimalarials | Start with 200 mg per day, no more than 6.5 mg/kg/day to be administered | Gastrointestinal upset, ocular toxicity, pruritus, drug eruptions, leucopenia, thrombocytopenia, haemolysis | Ocular toxicity more marked with chloroquine |
| Topical tacrolimus | 0.1% topical ointment | Burning, irritation of skin, pruritus | Contraindication- infections |
| Thalidomide | Initial dose of 100 to 200 mg/day, usual maintenance dose of 50 to 100 mg/day | Teratogenicity, polyneuropathy, drowsiness, nausea, skin eruptions, dryness of mouth and skin, oedema | Polyneuropathy uncommon with use of low doses |
| Azathioprine | Usual starting dose of 50 to 100 mg/day, usual maintenance dose of 25 to 50 mg/day | Myelosuppression, nausea, infections pancreatitis, rarely hepatotoxicity | Serum thiopurine methyltransferase should be measured |
| Cyclosporin | Initial dose of 4 to 5 mg/kg/day, which can be reduced with improvement | Hypertension, nephrotoxicity, hyperlipidemia, hypomagnesemia, gingival hyperplasia, headache, tremor, paresthesia, hypertrichosis, malignancy | Contraindications include uncontrolled hypertension, uncontrolled infections, and malignancy |
| Mycophenolate mofetil | Usual dose of 1 g twice a day | Gastric upset, headache, tremor, hypersensitivity, anemia, leucopenia and thrombocytopenia, infections, neoplasia | Full blood counts should be checked regularly |
| Methotrexate | 5 to 15 mg once a week followed by initial test dose of 2.5 mg | Gastrointestinal upset, myelosuppression, liver toxicity, pulmonary fibrosis | Monitor full blood count, liver function tests, and renal function |
| Acitretin | 0.5 to 1 mg/kg/day | Teratogenicity, hyperlipidemia, dryness of skin, mucous membranes, taste disturbances, hair loss | Monitor full blood count, liver function tests, fasting lipids |