Cutaneous Lupus Erythematosus — SCE Dermatology MCQ

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HardDermatopharmacologyCutaneous Lupus ErythematosusSCE Dermatology

A 38-year-old woman with active cutaneous lupus has failed Hydroxychloroquine and is being started on Mepacrine (Quinacrine). What is the key advantage of adding Mepacrine to Hydroxychloroquine?

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Correct answer: E — It has no retinal toxicity and can be safely combined with HCQ

Mepacrine (Quinacrine) is an antimalarial that does NOT cause retinal toxicity — its key advantage when used alongside or instead of Hydroxychloroquine for cutaneous lupus. It can be safely added to HCQ for synergistic effect without increasing retinopathy risk. Common side effects include yellow skin discolouration (reversible), GI upset, and rarely haemolysis in G6PD deficiency. BAD guidelines recommend Mepacrine as an add-on or alternative antimalarial for refractory CLE. The combination of HCQ + Mepacrine provides enhanced efficacy compared to either alone, while maintaining the safety profile regarding the eye.

Reference: BAD 2016 CLE Guidelines; BJD Antimalarials in Lupus