LUPUS ERYTHEMATOSUS Treatment

Chronic discoid lupus erythematosus is believed to be due to a localized auto-antibody phenomenon. It responds to anti-malarial drugs given by mouth and to inunction with betamethasone valerate and fluocinolone acetonide. Local injection of triamcinolone is used for stubborn lesions. Mepacrine, which was the first anti-malarial to be used, stains the skin yellow and chloroquine is now preferred. Chloroquine phosphate, 0.5 g. daily, is given initially and when the eruption has been brought under control, the smallest effective dose is given for maintenance—usually between 1 and 2 g. per week. It is convenient to reduce the dose by omitting certain days from treatment since this will give some relief from gastric irritation which is a common side-effect to chloroquine. The most serious toxic effects concern the eye. The patient complains of blurred vision which is caused by interference with accommodation. This disorder may cause inconvenience (reading, driving a car, etc.) but it is not in itself of grave signifi­cance. Serious ocular complications, however, include damage to the cornea, the retina and the optic nerve. Symptoms develop insidiously : complaints of coloured halos around lights are significant, and may herald serious impairment of vision. It is, therefore, most desirable that patients receiving prolonged courses of chloroquine should be seen regularly by an ophthalmologist. The affected skin should be protected from direct sunlight (these patients should never sunbathe) and from cold wind. Cosmetic preparations that hide the scars should be used.

Transition of the discoid form of the disease to the acute disseminated form occurs occasionally. This serious complication should be suspected when the eruption suddenly becomes more extensive or more livid ; and also if there is unexplained fever, toxasmia or lymphadenopathy. The onset of pulmonary, pericardial, renal or arthritic complications is also of sinister significance. These signs of dissemination call for treatment by corticosteroids given systemically with the patient at rest in bed.