Evolutive and therapeutic features of 24 cases of subacute cutaneous lupus

OBJECTIVE: Subacute cutaneous lupus is a clinical entity defined in 1979 by Sontheimer. Anti-malaria drugs are used as standard treatment for flare-up s, but in case of failure, less well-known alternative therapies may be use d. The aim of this work was to determine how patients with subacute cutaneo us lupus respond to these other treatments. PATIENTS AND METHODS: Twenty-four cases of subacute cutaneous lupus diagnos ed between 1980 and 1998 and followed for 5 years (mean, range 3 months to 16 years) were reviewed retrospectively. Anti-malaria drugs were used as fi rst line treatment in 23 cases and thalidomide alone or in combination in 1 3 cases. RESULTS: Prognosis of subacute cutaneous lupus was good in our series. Ther e was no renal involvement and none of the patients presented neurological involvement of the psychiatric type. Anti-malaria drugs were insufficient i n 13 cases. Thalidomide, either alone or in combination, was then used and was successful in 11 out of 13. Tolerance to treatment was good. Treatment withdrawal was required because of adverse effects in 4 out of 24 patients given anti-malaria drugs and in 3 out of 13 given thalidomide. DISCUSSION: Besides the good prognosis of subacute cutaneous lupus, our ser ies emphasizes the important contribution of thalidomide to second line tre atment. (C) 2000, Masson, Paris.