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Abstract
Background: Lupus erythematosus is a multisystem disorder that occurs throughout the world. Cape Town seems to be an area with a relatively high prevalence and the disease may be more severe in this area. The purely cutaneous form of the disorder, discoid lupus erythematosus (DLE) is potentially scarring and disfiguring, particularly in people with deeply pigmented skin. Many treatments have been used, but some are potentially toxic and some may cause foetal abnormalities if given to pregnant women. Many of these agents are very expensive, which limits their use in developing countries. Objectives: To report the results of a systematic review of treatments available for DLE.
Methods: A search strategy was used to identify all randomized controlled trials of drug treatments for DLE. MEDLINE, (1966 to November 1999), EMBASE (1980-1999) and the Cochrane Controlled trials Register were searched. Index Medicus was searched by hand for the years 1956 to 1966 and all reviews were scrutinized for references to studies. Members of the Cochrane Skin Group in Nottingham assisted with information and guidance at every stage of the review.
Results: There were 2 randomized controlled trials identified, one comparing potent steroid cream with low-potency steroid cream (Roenigk 1980) and the other comparing hydroxychloroquine with acitretin (Ruzicka 1992). Results of these trials showed that high potency was superior to low-potency steroid cream. Hydroxychloroquine and acitretin appeared to be of equal efficacy, although patients taking acitretin experienced more side effects. Neither study included a control group.
Conclusions: There is insufficient information to guide clinicians in the treatment of DLE. Randomized controlled trials, comparing chloroquine and potent topical steroids with other forms of therapy, are urgently needed.
References: 1. Roenigk HH, Martin JS, Eichorn P, Gilliam JN. Discoid lupus erythematosus. Diagnostic features and evaluation of topical corticosteroid therapy. Cutis 1980; 25: 281-5. 2. Ruzicka T, Sommerburg C, Goerz G, Kind P, Mensing H. Treatment of cutaneous lupus erythematosus with acitretin and hydroxychloroquine. Brit J Dermatol 1992; 127: 513-8.
Methods: A search strategy was used to identify all randomized controlled trials of drug treatments for DLE. MEDLINE, (1966 to November 1999), EMBASE (1980-1999) and the Cochrane Controlled trials Register were searched. Index Medicus was searched by hand for the years 1956 to 1966 and all reviews were scrutinized for references to studies. Members of the Cochrane Skin Group in Nottingham assisted with information and guidance at every stage of the review.
Results: There were 2 randomized controlled trials identified, one comparing potent steroid cream with low-potency steroid cream (Roenigk 1980) and the other comparing hydroxychloroquine with acitretin (Ruzicka 1992). Results of these trials showed that high potency was superior to low-potency steroid cream. Hydroxychloroquine and acitretin appeared to be of equal efficacy, although patients taking acitretin experienced more side effects. Neither study included a control group.
Conclusions: There is insufficient information to guide clinicians in the treatment of DLE. Randomized controlled trials, comparing chloroquine and potent topical steroids with other forms of therapy, are urgently needed.
References: 1. Roenigk HH, Martin JS, Eichorn P, Gilliam JN. Discoid lupus erythematosus. Diagnostic features and evaluation of topical corticosteroid therapy. Cutis 1980; 25: 281-5. 2. Ruzicka T, Sommerburg C, Goerz G, Kind P, Mensing H. Treatment of cutaneous lupus erythematosus with acitretin and hydroxychloroquine. Brit J Dermatol 1992; 127: 513-8.