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Hydroxychloroquine is a first-line systemic therapy for cutaneous lupus erythematosus (LE), but many patients have limited response for reasons that are unclear. In the early 1980s, my colleagues and I noted that extensive disease was more difficult to treat and had less response to antimalarial therapy (Arch Dermatol 1982; 118:412). Several studies associate smoking with lower response, and others suggest effects of pharmacogenetic factors.
These authors prospectively studied 200 patients with discoid LE who were prescribed hydroxychloroquine. One researcher reviewed the case notes for each patient, noting adjectives that indicated improvement or lack thereof in the first 6 months of therapy; no validated scoring system was used. In all, 12…