What is your approach to severe discoid lupus refractory to conventional topical and systemic therapies?

Agree with Dr. @Dr. First Last's comprehensive answer regarding the treatment of refractory DLE. However, would add two biological options, Belilumab and anifrolumab. In fact, just now evaluated with a fellow a patient in Lupus clinic with refractory DLE to intralesional steroids, Chloroquine after ...

In management of discoid lupus (DLE), first line therapies include topical corticosteroids, topical calcineurin inhibitors, and antimalarial therapy with hydroxychloroquine. Injected corticosteroids can be helpful for hyperkeratotic lesions and particularly for lesions affecting the scalp. If there ...

Below is a slide I present to fellows regarding the treatment of DLE, including many off-label options and some with minimal data. Dapsone is most effective for neutrophilic dermatosis which in CLE is mostly bullous lupus whereas ACLE, SCLE, and DLE are more lymphocytic. Moreover, although for HCQ a...

Absolutely agree with Dr. @Dr. First Last. We are having excellent responses in skin with anifrolumab, even in severe refractory disease. We have just published a case report of our first such success; she remains off steroids since 2 weeks after starting anifrolumab last year.

Shope et al., JAAD 20...

I have had excellent results with a 6-month or so course of lenalidomide. One of my patients not only has quiet discoid but is repigmenting her skin! She has been off for 2 years and continues to have skin pigment recovery.