Treatment options for refractory chilblain lupus

Summary: <br /> Chilblain lupus (CHLE), also called chilblain lupus erythematosus, is a rare subtype of cutaneous lupus erythematosus (CLE) that mainly affects the extremities in the cold. However, unlike Raynaud’s, these lesions do not completely resolve after the cold exposure. Current treatments for CHLE rely on avoidance and off-label medications. Oral steroids, calcium channel blockers, and topical steroids have been used to relieve vasoconstriction. However, many patients find these therapies ineffective or coupled with adverse side effects, emphasizing the demand for alternative therapies. Therefore, we conducted a systematic review to assess the safety and efficacy of alternative treatment options for CHLE. Of the treatments found, patients most often showed significant or complete responses to antimalarials (82%). Antimalarials were also the most common treatment used in the included studies (n=17/40). JAK inhibitors were the next most used treatment in this group (n=9) and also the next most effective (78%). For antimalarials, the most common side effect reported was persistent skin discoloration. For JAK inhibitors, 1 patient experienced transient thrombocytopenia that resolved with ruxolitinib holiday and did not recur upon reinitiation. The most promising treatments in this review were JAK inhibitors, given their similar efficacy and a more favorable safety profile than antimalarials. Atithi Patel¹, Lily Herbig¹, Paras Vakharia¹ 1. Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States. Adaptive and Auto-Immunity