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Response to Antimalarial Treatment in 36 Patients With Emphasis on Smoking

Alexander Kreuter, MD; Renata Gaifullina, MD; Christian Tigges, MD; Julia Kirschke, MD; Peter Altmeyer, MD; Thilo Gambichler, MD

Arch Dermatol. 2009;145(3):244-248.

Objective  To determine the efficacy of antimalarial drug use in patients with lupus erythematosus tumidus.

Design  Retrospective single-center study.

Setting  Dermatologic clinic at a university hospital.

Patients  Thirty-six patients with multifocal lupus erythematosus tumidus.

Intervention  Treatment with either chloroquine phosphate or hydroxychloroquine sulfate.

Main Outcome Measures  Cutaneous Lupus Erythematosus Disease Area and Severity Index score.

Results  Treatment with antimalarial drugs resulted in a significant reduction in the Cutaneous Lupus Erythematosus Disease Area and Severity Index score, from 4 (range, 2-8) at baseline to 1 (range, 0-6) after 3 months of therapy (P < .001). Twenty-two patients (61%) exhibited complete or almost complete clearance of skin lesions, consistent with a clinical score of 0 or 1. No difference in efficacy was noted between the chloroquine-treated group and the hydroxychloroquine-treated group (P = .40). Adverse effects (nausea, dizziness, and headache) occurred only in patients treated with chloroquine. Twenty-eight patients (78%) were smokers, and smokers had a significantly higher mean (SD) clinical score than nonsmokers (5.1 [1.8] vs 3.3 [1.6]; P = .03). Moreover, smokers had a significantly lower reduction in clinical score with antimalarial treatment compared with nonsmokers (r = 0.30; P = .03; 95% confidence interval, –0.05 to 0.57). Eighty-eight percent of nonsmokers (7 of 8 patients) but only 57% of smokers (16 of 28 patients) had a clinical score of 1 or 0 after 3 months of treatment with antimalarial drugs.

Conclusions  These retrospective study findings demonstrate that antimalarial treatment is highly effective in multifocal lupus erythematosus tumidus. Lower incidence of adverse effects and equal efficacy might favor the use of hydroxychloroquine. Patients who smoke should be encouraged to join smoking cessation programs because they will respond better to antimalarial treatment.

Author Affiliations: Connective Tissue Disease Research Unit, Department of Dermatology, Ruhr University Bochum, Bochum, Germany.

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