Discoid Lupus Treatment — SCE Rheumatology MCQ

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ModerateSLE & Antiphospholipid SyndromeDiscoid Lupus TreatmentSCE Rheumatology

A 40-year-old woman with discoid lupus erythematosus has scarring alopecia hypopigmented atrophic plaques on her face and scalp follicular plugging. Only 5% of DLE patients develop systemic SLE. What is the most important treatment to prevent scarring?

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Correct answer: C — Topical and/or intralesional corticosteroids plus Hydroxychloroquine and strict sun protection

Discoid lupus erythematosus causes permanent scarring and pigment change if not treated promptly. First-line treatment includes potent topical corticosteroids intralesional corticosteroid injections and systemic Hydroxychloroquine (which reduces disease activity and recurrence). Strict photoprotection (SPF ≥50 broad-spectrum sunscreen protective clothing) is essential as UV exposure triggers flares. Second-line options for refractory disease include Methotrexate Mycophenolate Dapsone and Thalidomide. Early treatment prevents irreversible scarring alopecia and disfigurement. Only about 5% of isolated DLE patients progress to systemic SLE.

Reference: Kuhn A et al 2017 cutaneous lupus management; EULAR 2023 SLE recommendations