Smoking Cutaneous Lupus Erythematosus Patients Have More Severe Disease, Lower Response to Antimalarials

Jeffrey P. Callen, MD

Intervene as best as you can in any smoker, but by all means do so in patients with CLE.

The effects of smoking on disease severity in patients with cutaneous lupus erythematosus (CLE) and the impact on the efficacy of antimalarial therapy in these patients remain controversial. These authors performed an analysis of 838 patients with a history of tobacco smoking who were treated for various subtypes of CLE at 30 centers in 14 European countries (although roughly two thirds of the patients were seen at centers in Germany).

Disease severity and activity was measured using the validated Cutaneous Lupus Erythematosus Disease Area and Severity Index (CLASI). Severity was significantly higher in active smokers and those with smoking history. This finding held true for all subsets of CLE, including acute cutaneous LE, subacute CLE, chronic CLE, and what the authors term intermittent CLE. The latter term is not commonly used in the U.S. and may include tumid LE. Antimalarial therapy was judged to be significantly more effective in nonsmokers. The authors suggest that hydroxychloroquine is more efficacious than chloroquine in these patients. However, this observation may be confounded because patients were selected to receive chloroquine therapy if they were deemed to be resistant to hydroxychloroquine.

Citation(s):

Kuhn A et al. Influence of smoking on disease severity and antimalarial therapy in cutaneous lupus erythematosus: Analysis of 1002 patients from the EUSCLE database. Br J Dermatol 2014 Mar 26; [e-pub ahead of print].