Hydroxychloroquine (HCQ) is used as the first-line systemic treatment for severe, widespread or refractory
cutaneous lupus erythematosus (CLE) in many countries. However HCQ is not an approved
drug in Japan. For the establishment of HCQ
therapy as the alternative treatment for CLE in Japan, we conducted a pilot study in Japanese patients with refractory CLE by administrating HCQ, and evaluated the improvements in the skin lesions using the
Cutaneous Lupus Erythematosus Disease Area and Severity Index (CLASI). We administrated HCQ to seven CLE cases, including four
systemic lupus erythematosus (SLE) cases. The skin lesions of the four cases improved dramatically, and their mean CLASI activity index decreased significantly following HCQ treatment.
Arthralgia improved in all three cases with
arthralgia and general malaise also improved in two of the three cases who had complained. In three cases who discontinued HCQ
therapy after 16 weeks of treatment, their skin lesions and general malaise worsened soon, and after the resumption of HCQ
therapy these symptoms improved again. The mean serum
triglyceride and total
cholesterol levels also decreased significantly at the end of this study. Our results suggest that HCQ might be effective for Japanese SLE skin lesions and CLE, and support the studies which reported that HCQ prevented clinical flare ups of SLE. An additional effect to improve
lipid profiles was also observed in our Japanese cases. It is necessary to confirm that these effects are reproducible when Japanese lupus erythematosus cases are given HCQ.