Jessop Sue, Whitelaw David A, Delamere Finola M
Dermatology, Groote Schuur Hospital, 27 Roosevelt Road, CLAREMONT, Cape Town, South Africa, 7708.
Cochrane Database Syst Rev. 2009 Oct 7(4):CD002954. doi: 10.1002/14651858.CD002954.pub2.
Discoid lupus erythematosus is a chronic form of cutaneous (skin) lupus which can cause permanent scarring if treatment is inadequate. Many drugs have been used to treat this disease and some of these are potentially very toxic.
To assess the effects of drugs for discoid lupus erythematosus.
In June 2009 we updated our searches of the Cochrane Skin Group Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library (Issue 2, 2009), MEDLINE, EMBASE, LILACS, and online ongoing trials registers. The reference lists of relevant reviews were searched. Index Medicus (1956 to 1966) was handsearched and we approached authors for information about unpublished trials.
We included all randomised trials of drugs to treat people with discoid lupus erythematosus. Drugs included in the search were azathioprine, chloroquine, clofazimine, corticosteroids, (oral and topical), dapsone, gold, interferon alpha-2a, methotrexate, phenytoin, retinoids, sulphasalazine, thalidomide, topical calcineurin blockers (pimecrolimus and tacrolimus), and biological agents (etanercept, efalizimab, infliximab, and rituximab).
Two reviewers independently examined each retrieved study for eligibility.
Two trials involving 136 participants were included. No new trials were included in this update.In a cross-over study of 12 weeks duration, fluocinonide 0.05% cream (a potent topical corticosteroid), appeared to be better than hydrocortisone 1% cream (a mild corticosteroid) when the first arm of the trial involving 78 participants was analysed at 6 weeks. Clearing or excellent improvement was seen in 27% of people using fluocinonide and in 10% of those using hydrocortisone, giving a 17% absolute benefit in favour of fluocinonide (95% CI 0.0 to 0.34, NNT (Number needed to treat) 6).In the second trial, acitretin (50mg/day) was compared with hydroxychloroquine (400mg/day) in 58 people in a parallel trial of 8 weeks duration. There was marked improvement or clearing in 46% of people using acitretin and in 50% of those on hydroxychloroquine but there was no significant difference between the 2 interventions. The adverse effects were more frequent and more severe in the acitretin group. In this trial clearing of erythema was measured and found to be better in the hydroxychloroquine group (RR 0.61, 95% CI 0.36 to 1.06).
AUTHORS' CONCLUSIONS: Fluocinonide cream may be more effective than hydrocortisone in treating people with discoid lupus erythematosus. Hydroxychloroquine and acitretin appear to be of equal efficacy, although adverse effects are more frequent and more severe with acitretin. There is not enough reliable evidence about other drugs used to treat discoid lupus erythematosus.
盘状红斑狼疮是一种慢性皮肤型狼疮，如果治疗不当可导致永久性瘢痕形成。许多药物已被用于治疗这种疾病，其中一些可能具有很大毒性。
评估治疗盘状红斑狼疮的药物疗效。
2009年6月，我们更新了对Cochrane皮肤组专业注册库、Cochrane图书馆（2009年第2期）中的Cochrane对照试验中心注册库（CENTRAL）、MEDLINE、EMBASE、LILACS以及在线正在进行的试验注册库的检索。检索了相关综述的参考文献列表。手工检索了《医学索引》（1956年至1966年），并向作者咨询未发表试验的信息。
我们纳入了所有治疗盘状红斑狼疮患者的药物随机试验。检索中包括的药物有硫唑嘌呤、氯喹、氯法齐明、皮质类固醇（口服和外用）、氨苯砜、金制剂、干扰素α-2a、甲氨蝶呤、苯妥英、维甲酸、柳氮磺胺吡啶、沙利度胺、外用钙调神经磷酸酶抑制剂（吡美莫司和他克莫司）以及生物制剂（依那西普、依法利珠单抗、英夫利昔单抗和利妥昔单抗）。
两名综述作者独立检查每个检索到的研究是否符合纳入标准。
纳入了两项涉及136名参与者的试验。本次更新未纳入新的试验。在一项为期12周的交叉试验中，当对试验第一组的78名参与者在6周时进行分析时，0.05%氟轻松乳膏（一种强效外用皮质类固醇）似乎比1%氢化可的松乳膏（一种温和皮质类固醇）效果更好。使用氟轻松的人中27%病情清除或显著改善，使用氢化可的松的人中这一比例为10%，氟轻松的绝对获益为17%（95%CI 0.0至0.34，需治疗人数6）。在第二项试验中，在一项为期8周的平行试验中，对58人比较了阿维A（50mg/天）与羟氯喹（400mg/天）。使用阿维A的人中46%病情显著改善或清除，使用羟氯喹的人中这一比例为50%，但两种干预措施之间无显著差异。阿维A组的不良反应更频繁且更严重。在该试验中对红斑清除情况进行了测量，发现羟氯喹组更好（RR 0.61，95%CI 0.36至1.06）。
氟轻松乳膏在治疗盘状红斑狼疮患者方面可能比氢化可的松更有效。羟氯喹和阿维A似乎疗效相当，尽管阿维A的不良反应更频繁且更严重。关于用于治疗盘状红斑狼疮的其他药物，没有足够可靠的证据。
