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Treatment of lupus skin involvement with quinacrine and hydroxychloroquine

Rheumatology Unit and Chair – A.O. Spedali Civili di Brescia– Università degli Studi di Brescia, Italyilariacava{at}virgilio.it

R Sala

Dermatology Unit and Chair – A.O. Spedali Civili di Brescia– Università degli Studi di Brescia, Italy

C Bazzani

Rheumatology Unit and Chair – A.O. Spedali Civili di Brescia– Università degli Studi di Brescia, Italy

A Ceribelli

Rheumatology Unit and Chair – A.O. Spedali Civili di Brescia– Università degli Studi di Brescia, Italy

C Zane

Dermatology Unit and Chair – A.O. Spedali Civili di Brescia– Università degli Studi di Brescia, Italy

R Cattaneo

Rheumatology Unit and Chair – A.O. Spedali Civili di Brescia– Università degli Studi di Brescia, Italy

A Tincani

Rheumatology Unit and Chair – A.O. Spedali Civili di Brescia– Università degli Studi di Brescia, Italy

PG Calzavara-Pinton

Dermatology Unit and Chair – A.O. Spedali Civili di Brescia– Università degli Studi di Brescia, Italy

F Franceschini

Rheumatology Unit and Chair – A.O. Spedali Civili di Brescia– Università degli Studi di Brescia, Italy

To evaluate the efficacy of hydroxychloroquine (HCQ) and quinacrine (Qn) association, at two different dosages, in treatment of lupus skin lesions not responding to HCQ alone. Thirty-four patients, affected by cutaneous and systemic lupus erythematosus, were retrospectively analysed. They were treated by HCQ (5 mg/Kg/qd) and Qn with two regimens: 100 mg/qd (29 cases) and 50 mg/qd (5 cases). Discoid lupus erythematosus (19 cases), acute malar rash (6 cases), chilblain lupus (4 cases) showed a significant improvement with combination therapy (P = 0.009, P = 0.019, and P = 0.04, respectively). Ten patients with subacute cutaneous lupus showed a partial response, whereas lupus profundus didn’t improve. The same overall response rate was recorded comparing two Qn regimens, but subjects taking 100 mg/qd improved more rapidly than the others (P = 0.001). Ten patients developed side effects, mainly represented by skin yellowish discolouration. Depression and severe headache with nausea, which were globally recorded in two cases, led to drug withdrawal. One additional case of hepatitis was recorded in a patient with preexisting Hepatitis C virus (HCV) infection. Combination of HCQ and Qn is rapidly effective at 100 mg/qd and well tolerated in the treatment of lupus skin lesions unresponsive to HCQ alone.

Key Words: cutaneous lupus • discoid lupus • hydroxychloroquine • subacute cutaneous lupus • quinacrine

Lupus, Vol. 18, No. 8, 735-739 (2009)
DOI: 10.1177/0961203308101714


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