Miscellaneous

In a single study, 90% of 93 patients with chronic CLE showed very good results after oral phenytoin therapy at 300 mg/day for up to 6 months (Rodriquez-Castellanos et al. 1995). Prolonged remission of 6-12 months was observed in about one third of those patients in whom follow-up data were available. Minimal side effects seen in this study are counteracted by the potential risk of toxic epidermal necrolysis caused by phenytoin.

Sulfasalazine is well established in the treatment of inflammatory bowel diseases and various arthritides. Its effectiveness for CLE at a dose of 2 g/d has been suggested by a couple of case reports and small studies (Carmichael and Paul 1991, Delaporte et al. 1997, Ferda 1996). All patients that responded were rapid acetylators, whereas nonresponders were slow acetylators. However, severe side effects, especially hyper-sensitivity reactions, limit its use.

Another antibiotic with favorable effects was recently described in three cases of SCLE. The second-generation oral cephalosporin cefuroxime axetil cleared skin lesions within 6-8 weeks at a dose of 500mg/d (Rudnicka 2000). The effect seems to be specific for this individual cephalosporin as others from this group did not work. Immunomodulatory effects beyond antibiotic activity may be involved.

Ambiguous results are found for vitamin E or tocopherol at doses of 8002000 IU/d (Ayers andMihan 1974, Duna 1995,Wallace 2001,2002). Its mechanisms of action are unknown. Only fair responses have been found in open trials for DLE and SCLE at low doses, whereas adequate dosing resulted in marked improvement, especially in superficial disease of recent onset. These results, however, are discussed controversially, and vitamin E is not generally recommended.

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