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Cutaneous lupus — SCE Rheumatology MCQ

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HardConnective tissue diseasesCutaneous lupusSCE Rheumatology

A patient with SLE has persistent biopsy-compatible active cutaneous lupus despite photoprotection, smoking cessation, topical treatment and adherent hydroxychloroquine at an appropriate dose. There is no major-organ flare. What is the best next principle?

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Correct answer: D — Add steroid-sparing systemic treatment while continuing hydroxychloroquine

Explanation lettering: D = shown as A · A = shown as B · E = shown as C · C = shown as D · B = shown as E

C is correct. Persistent clinically important cutaneous activity after foundational therapy warrants a steroid-sparing systemic option selected for phenotype, comorbidity and access; repeated glucocorticoid bursts accumulate harm. A removes foundational therapy. B substitutes toxicity for control. D grossly over-treats non-organ-threatening disease. E delays treatment until irreversible morbidity appears.

Reference: BSR 2026 guideline for systemic lupus erythematosus across the life course: https://academic.oup.com/rheumatology/article/65/6/keag223/8713811