Dawaa Reference

acute

Discoid lupus erythematosus

Treatment options, dosing, cautions and Egyptian brands from the shipped Dawaa Reference card.

Evidence status

Checked against the sources named below

Sources3 sources

Egyptian National Drug Formulary - Antimicrobial 2023, Hydroxychloroquine monograph, PDF page index 87 (printed p78), under "Discoid lupus erythematosus and subacute cutaneous lupus erythematosus" (the citation previously named p88, which is the following page). · Sukumaran S, Sathe NC. Discoid Lupus Erythematosus. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2026 Jan-. Bookshelf ID: NBK493145. · Protopic 0.1% ointment SmPC section 4.2 (eMC product 1608)

Verified against3 documents
  • Egyptian National Drug Formulary - Antimicrobial 2023, Hydroxychloroquine monograph, PDF page index 87 (printed p78), under "Discoid lupus erythematosus and subacute cutaneous lupus erythematosus".
  • Egyptian National Drug Formulary (endf-respiratory-2026.txt)
  • Sukumaran S, Sathe NC. Discoid Lupus Erythematosus. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2026 Jan-. Bookshelf ID: NBK493145.

Verified date2026-08

Presentation reference

Is it this?

Reference only, to read alongside your own examination.

Symptoms — what the patient reports (6)

  • A localized form (80%) affects the face, ears, and scalp, while a disseminated form (20%) involves sites above and below the neck
  • The disseminated form, especially with trunk involvement, carries up to a 28% risk of progressing to systemic lupus
  • Lesions below the neck rarely occur without disease also above the neck
  • The lips, nose lining, conjunctiva, and genital mucosa can occasionally be affected
  • A photodistributed pattern occurs in some patients, though lesions can also arise on sun-protected skin
  • Joint aches can accompany discoid lesions, but only about 10% to 20% of these patients go on to meet SLE criteria [joint pain]

Signs — what you find (6)

  • Lesions begin as a well-defined, ring-shaped red patch or plaque with adherent follicular scaling [plaques · scaling]
  • Peeling back the adherent scale reveals follicular keratotic spikes, the carpet-tack sign
  • Lesions expand with peripheral inflammation and hyperpigmentation, leaving central atrophy, scarring, telangiectasia, and hypopigmentation [atrophy · pigmentation change · scarring · telangiectasia]
  • Scalp involvement can progress to permanent scarring alopecia [hair loss · scarring]
  • Squamous cell carcinoma can arise in a longstanding lesion in 2% to 3% of cases and often carries a poor prognosis
  • A rare hypertrophic variant shows thick, wart-like plaques [plaques]

Tests (4)

  • An ANA titer is the first step - highly sensitive (95% to 100%) but not specific
  • SSA/Ro, SSB/La, U1RNP, histone, and ssDNA autoantibodies often turn up in SLE, but none of them pin down this cutaneous subtype
  • Anti-annexin 1 antibodies are being explored as a possible new marker, though levels do not track disease activity
  • Histological examination may be needed to confirm a diagnosis made mainly on clinical grounds

If not this — what else fits (12)

  • Granuloma faciale is on the differential
  • Tinea faciei is on the differential
  • Cutaneous tuberculosis is on the differential
  • Cutaneous leishmaniasis is on the differential
  • Lymphoproliferative disorders are on the differential
  • Lichen planopilaris is a differential for the scarring alopecia this condition can cause
  • Tinea capitis is a differential for the scarring alopecia it can cause
  • Central centrifugal cicatricial alopecia is a differential for the scarring alopecia it can cause
  • Keratoacanthoma is a differential for the hypertrophic variant
  • Squamous cell cancer is a differential for the hypertrophic variant
  • Hypertrophic lichen planus is a differential for the hypertrophic variant
  • Prurigo nodularis is a differential for the hypertrophic variant

SourceStatPearls "Discoid Lupus Erythematosus" - disease-level clinical article

Presentation findings are traced to the source above.

Rx: Main treatment | Facial lesions - avoids steroid skin thinning

MAIN TREATMENT

1

HYDROXYCHLOROQUINE

1st line

Formoral.solid

Adult dose and duration

200 to 400 mg by mouth daily, as a single dose or in two divided doses - but not more than 5 mg/kg/day of actual body weight, or 400 mg daily, whichever is lower. Doses are expressed as hydroxychloroquine sulfate (200 mg sulfate = 155 mg base). - Long-term therapy. The formulary states no course length for discoid lupus.

Paediatric dose

The formulary gives no paediatric lupus dose - its paediatric hydroxychloroquine section covers malaria only (chemoprophylaxis 6.5 mg/kg weekly; treatment 12.9 mg/kg then 6.5 mg/kg). Paediatric discoid lupus is a specialist decision; do not carry the malaria figures across.

Dose source

Egyptian National Drug Formulary - Antimicrobial 2023, Hydroxychloroquine monograph, PDF page index 87 (printed p78), under "Discoid lupus erythematosus and subacute cutaneous lupus erythematosus".

Why

Hydroxychloroquine is formulary-indicated by name for discoid lupus erythematosus and is the standard systemic agent for chronic disease not controlled by photoprotection and topical steroids alone.

Cautions
  • All doses are hydroxychloroquine sulfate; 200 mg sulfate = 155 mg base.
  • Eye check at baseline, then annual retinal screening from 5 years of use, or sooner if major risk factors are present.
  • Do not exceed 5 mg/kg/day of actual body weight or 400 mg daily, whichever is lower - retinal toxicity.
  • Systemic symptoms (joint pain, renal involvement, cytopenias) suggesting progression to systemic lupus erythematosus.
  • Due to the risk of retinal toxicity, most patients should not receive a daily dose above 5 mg/kg actual body weight or 400 mg, whichever is lower; baseline and periodic ophthalmologic screening is recommended for long-term use.
  • Systemic symptoms - joint pain, renal involvement, or cytopenias - suggest progression to systemic lupus erythematosus and need dermatology/rheumatology referral.
  • Use with caution in G6PD deficiency and in pre-existing retinopathy or maculopathy.
  • Skin diagnosis should ideally be confirmed and monitored with dermatology involvement.
Egyptian brands
Egyptian brandManufacturerIndicative price
FUTARHOMAL 200 MG 20 F.C.TABS.FUTURE PHARMACEUTICAL INDUSTRIES (FPI)40.00 EGP (2.00/unit)
HYDROXYTOID 200 MG 20 F.C.TABS.EVA PHARMA40.00 EGP (2.00/unit)
HYDROQUINE 200 MG 20 TABS.MINA PHARM82.00 EGP (4.10/unit)
PLAQUENIL 200MG 60 F.C.TABS.SANOFI246.00 EGP (4.10/unit)
2

BECLOMETASONE

add-on - not a substitute

Formtopical

Adult dose and duration

Apply 0.25 mg/g cream thinly over affected area twice daily initially; extend application interval as improvement is seen

Paediatric dose

Cream should be applied thinly over the whole of the affected area and gently rubbed in.

Dose source

Egyptian National Drug Formulary (endf-respiratory-2026.txt)

Why

Potent topical corticosteroid formulary-indicated for discoid lupus erythematosus to suppress local cutaneous inflammation during flares.

Cautions
  • Avoid long-term continuous use due to risk of skin atrophy.
  • Use with caution on facial skin and delicate skin folds.
Egyptian brands
Egyptian brandManufacturerIndicative price
BECLOZONE 0.025% CREAM 20 GMMEMPHIS5.00 EGP

FACIAL LESIONS - AVOIDS STEROID SKIN THINNING - give alongside

3

TACROLIMUS

Facial lesions - avoids steroid skin thinning

add-on - not a substitute

Formtopical

Adult dose and duration

0.1% ointment applied thinly twice a day until the lesion clears - Until the lesion clears

Paediatric dose

Only the 0.03% strength is used between 2 and 16 years. Not for children under 2.

Dose source

Protopic 0.1% ointment SmPC section 4.2 (eMC product 1608)

Why

The card's only topical is a corticosteroid, and the article warns that chronic topical steroid on the face causes atrophy; a calcineurin inhibitor does the same job on facial lesions without thinning the skin.

Cautions
  • Sun exposure has to be minimised while using it - hat, clothing and sunscreen - and sunbeds and UV therapy avoided. This matters doubly in discoid lupus, where sunlight drives the disease.
  • Do not apply it to any lesion that could be malignant or pre-malignant, and have any new change within a treated patch looked at.
  • A burning or stinging feeling for the first week or two after application is the usual side effect and settles.
  • Use the lowest strength, the fewest applications and the shortest course that controls the lesion; this is not a treatment to leave running indefinitely.
  • Its licensed indication is atopic dermatitis, so use in discoid lupus is off-label and should be explained to the patient.
Egyptian brands
Egyptian brandManufacturerIndicative price
TAROLIMUS 0.1% TOPICAL OINT. 15 GMANDALOUS PHARMA144.00 EGP
TRECZIMUS 0.1% TOPICAL OINT. 30 GMMARCYRL PHARMACEUTICAL INDUSTRIES (MPI)219.00 EGP
PROTOPIC 0.1 % OINT. 30 GMLEO PHARMACEUTICAL PRODUCTS407.00 EGP
TRECZIMUS 0.03% TOPICAL OINT. 20 GMMARCYRL PHARMACEUTICAL INDUSTRIES (MPI)114.00 EGP
TAROLIMUS 0.03% TOPICAL OINT. 15 GMANDALOUS PHARMA129.00 EGP
PROTOPIC 0.03 % OINT. 30 GMLEO PHARMACEUTICAL PRODUCTS371.00 EGP

Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy.