# Discoid lupus erythematosus - Category: acute - Review status: reviewed (every claim checked against a document named on this page) - 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 date: 2026-08 ## Verified against - 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. ## Treatment metadata - Hydroxychloroquine — oral.solid - Beclometasone — topical - Tacrolimus — topical ## Complete treatment card ```text DISCOID LUPUS ERYTHEMATOSUS 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) Review status: REVIEWED against 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. (2026-08) 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 Source StatPearls "Discoid Lupus Erythematosus" - disease-level clinical article Status traced to the source above Rx: Main treatment | Facial lesions - avoids steroid skin thinning MAIN TREATMENT 1. HYDROXYCHLOROQUINE [1st line] Adult 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. Peds 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. 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. Caution 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. Egypt FUTARHOMAL 200 MG 20 F.C.TABS. FUTURE PHARMA... 40.00 EGP (2.00/unit) HYDROXYTOID 200 MG 20 F.C.TABS. EVA PHARMA 40.00 EGP (2.00/unit) HYDROQUINE 200 MG 20 TABS. MINA PHARM 82.00 EGP (4.10/unit) PLAQUENIL 200MG 60 F.C.TABS. SANOFI 246.00 EGP (4.10/unit) 2. BECLOMETASONE [add-on - not a substitute] Adult Apply 0.25 mg/g cream thinly over affected area twice daily initially; extend application interval as improvement is seen Peds Cream should be applied thinly over the whole of the affected area and gently rubbed in. 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. Caution Avoid long-term continuous use due to risk of skin atrophy. Use with caution on facial skin and delicate skin folds. Egypt BECLOZONE 0.025% CREAM 20 GM MEMPHIS 5.00 EGP FACIAL LESIONS - AVOIDS STEROID SKIN THINNING - give alongside 3. TACROLIMUS [add-on - not a substitute] Adult 0.1% ointment applied thinly twice a day until the lesion clears - Until the lesion clears Peds Only the 0.03% strength is used between 2 and 16 years. Not for children under 2. 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. Caution 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. Egypt TAROLIMUS 0.1% TOPICAL OINT. 15 GM ANDALOUS PHARMA 144.00 EGP TRECZIMUS 0.1% TOPICAL OINT. 30 GM MARCYRL PHARMACEUTICAL INDUSTRIES (MPI) 219.00 EGP PROTOPIC 0.1 % OINT. 30 GM LEO PHARMACEU... 407.00 EGP TRECZIMUS 0.03% TOPICAL OINT. 20 GM MARCYRL PHARMACEUTICAL INDUSTRIES (MPI) 114.00 EGP TAROLIMUS 0.03% TOPICAL OINT. 15 GM ANDALOUS PHARMA 129.00 EGP PROTOPIC 0.03 % OINT. 30 GM LEO PHARMACEU... 371.00 EGP Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)