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Case Report/Case Series |

Treatment of Scarring Alopecia in Discoid Variant of Chronic Cutaneous Lupus Erythematosus With Tacrolimus Lotion, 0.3%

Emily C. Milam, BA1; Sarika Ramachandran, MD1; Andrew G. Franks Jr, MD1
[+] Author Affiliations
1Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, New York
JAMA Dermatol. 2015;151(10):1113-1116. doi:10.1001/jamadermatol.2015.1349.
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Importance  Discoid lupus erythematosus (DLE) is a chronic variant of cutaneous lupus erythematosus, an autoimmune inflammatory disorder of the skin. Lesions are often localized to the scalp and can result in permanent scarring, disfiguration, and irreversible alopecia. Although DLE usually responds to topical or intralesional corticosteroids and/or oral antimalarials, some DLE is resistant to these treatments or adverse effects limit their effectiveness.

Observations  Three patients with treatment-refractory, biopsy-proved DLE were prescribed a novel, off-label preparation of tacrolimus lotion, 0.3%, in an alcohol base as an adjunct to oral antimalarial therapy. All 3 patients demonstrated improvement in lesion severity and hair regrowth with the use of this regimen after 3 months and continued improvement thereafter. We report a retrospective analysis of these 3 cases.

Conclusions and Relevance  This report is, to our knowledge, the first mention of tacrolimus being used in a lotion formulation to treat DLE lesions, resulting in hair regrowth. Topical tacrolimus lotion, 0.3%, in an alcohol base may be a potential therapeutic option for patients with DLE that is refractory to first-line therapies and who risk late-stage disease with permanent scarring alopecia.

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Treatment of Active Chronic Discoid Lupus Erythematosus of the Scalp in Patient 1

A, Before application of topical tacrolimus lotion, 0.3%, the scalp demonstrates alopecia and signs of disease activity, including erythema and scale. B, After 6 months of tacrolimus therapy as an adjunct to chloroquine phosphate, the scalp shows a reduction in erythema and scale and increased hair regrowth.

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