Department of Dermatology and Pediatrics, University of Wisconsin Madison School of Medicine and Public Health, Madison, WI, U.S.A.
Department of Biostatistics, University of Wisconsin Madison School of Medicine and Public Health, Madison, WI, U.S.A.
Br J Dermatol. 2019 Oct;181(4):805-810. doi: 10.1111/bjd.17780. Epub 2019 Jun 23.
Children with discoid lupus erythematosus (DLE) are at risk for disfigurement and progression to systemic lupus erythematosus (SLE). Consensus is lacking regarding optimal care for children with DLE.
The aim of this study was to compare practice patterns among paediatric dermatologists/rheumatologists treating paediatric DLE.
An online survey was sent to 292 paediatric rheumatologists in the Childhood Arthritis and Rheumatology Research Alliance and 200 paediatric dermatologists in the Pediatric Dermatology Research Alliance. Consensus was defined as ≥ 70% agreement.
Survey response rates were 38% (76 of 200) for dermatology and 21% (60 of 292) for rheumatology. Both specialties agreed that screening labs should include complete blood counts with differential, urinalysis, complement levels, erythrocyte sedimentation rate, antinuclear antibody and other autoantibodies, hepatic function and renal function/electrolytes. Both specialties agreed that arthritis or nephritis should prompt intensified evaluation for SLE. No other patient features achieved consensus as disease-modifying risk factors. Hydroxychloroquine was agreed upon as first-line systemic therapy, but consensus was lacking for second- or third-line treatment.
We found few areas of consensus and significant practice differences between paediatric dermatologists and rheumatologists treating DLE. Knowledge gaps include risk factors for SLE, optimal screening and treatment of refractory skin disease.
患有盘状红斑狼疮（DLE）的儿童有毁容和发展为系统性红斑狼疮（SLE）的风险。目前对于 DLE 患儿的最佳治疗方法尚未达成共识。
本研究旨在比较治疗儿童 DLE 的儿科皮肤科医生/风湿病医生的实践模式。
我们向儿童关节炎和风湿病研究联盟的 292 名儿科风湿病医生和儿科皮肤病研究联盟的 200 名儿科皮肤科医生发送了在线调查。将共识定义为≥70%的一致意见。
皮肤科的调查回复率为 38%（200 人中的 76 人），风湿病的回复率为 21%（292 人中的 60 人）。两个专业都认为筛选实验室应包括全血细胞计数、尿液分析、补体水平、红细胞沉降率、抗核抗体和其他自身抗体、肝功能和肾功能/电解质。两个专业都认为关节炎或肾炎应提示加强 SLE 的评估。没有其他患者特征被认为是疾病修饰的危险因素。羟氯喹被认为是一线系统治疗药物，但二线或三线治疗缺乏共识。
我们发现治疗 DLE 的儿科皮肤科医生和风湿病医生之间几乎没有共识，实践差异很大。知识差距包括 SLE 的危险因素、最佳筛查和治疗难治性皮肤病。
