What is your approach for severe SCLE in patients unable to tolerate HCQ?

1. 30% of subacute cutaneous lupus erythematosus (SCLE) is worsened by or caused by drugs, especially PPIs, calcium channel blockers (CCBs), thiazides, minocycline, and anti-fungal meds. Very different from other drug-induced disorders, the culprit drug could have been started months to years (as long...

I would make sure they are not taking a drug that could cause SCLE, like omeprazole or another PPI. You could try methotrexate or mycophenolate mofetil. Anifrolumab would probably work but is hard to get unless the patient has SLE. Lenalidomide is a thalidomide derivative that works well for very re...

I have found that adding 15-25 mg/week sc Methotrexate works very well for SCLE that is insufficiently responsive to HCQ or for patients unable to take HCQ. Failing that, anifrolumab provided the patient has sufficient SLE criteria to access it.

With regard to HCQ intolerance, whether it be GI intol...