How would you approach management of a young male patient with discoid lupus who has had minimal response to hydroxychloroquine (and subtherapeutic whole blood levels) who continues to use tobacco products?
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How would you approach management of a young male patient with discoid lupus who has had minimal response to hydroxychloroquine who continues to use tobacco products?
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2 Answers
Mednet MemberInvited Expert
Rheumatology · Uniformed Services University of the Health Sciences (USUHS)
Answered on · Updated on
- First, is he taking his HCQ (55% chance he is not)? Check a trough whole blood HCQ drug level and you want it to be 1000 - 1200 ng/mL (that is my goal in uncontrolled lupus; 750 - 1200 is fine in lupus under remission per Garg et al., PMID 37667434). Thanks, @Dr. First Last for reminding me. :-)
- When I read this question, several similar discoid lupus erythematosus (DLE) patients pop up in my mind that I've seen over the years. All were very difficult to treat, speaking to how bad smoking and c...
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Mednet Member
Rheumatology · University of Chicago
Answered on · Updated on
- I would definitely encourage tobacco cessation no matter what medication, not only for his skin but for overall health.
- I'd check HCQ levels to see if he is taking and/or therapeutic.
- Presuming he is not taking it/missing doses, I would start Saphnelo for increased compliance
- If he is taking would refer to derm for Thalidomide, as Dr. @Dr. First Last pointed out.
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