Cutaneous lupus erythematosus (CLE) is a disfiguring and potentially disabling disease that causes significant morbidity in patients. Antimalarials are an important class of medication used to treat this disease and have been the first-line systemic therapy since the 1950s. Quinacrine, in particular, is used as an adjuvant therapy to other antimalarials for improved control of CLE. Quinacrine is currently unavailable in the USA, which has taken away an important component of the treatment regimen of patients with CLE. This paper reviews the evidence of available local and systemic therapies in order to assist providers in choosing alternative treatments for patients who previously benefited from quinacrine therapy.

ObjectiveThere is a need to identify concerns unique to patients with cutaneous lupus erythematosus (CLE), which may not be captured by current common-practice dermatological quality-of-life tools. This study formally characterises what bothers patients with CLE about their disease by conducting semistructured, qualitative interviews.MethodsSixteen patients with CLE were interviewed about how their cutaneous findings impact their daily life. Each interview was transcribed, coded and categorised for recurrent themes. Current CLE activity and damage were also assessed by the Cutaneous Lupus Activity and Severity Index tool.ResultsResponses were categorised into six themes, including Fear of Disease Progression, Unwanted Attention, Self-Consciousness, Physical Signs/Symptoms, Emotional Symptoms and Functional Decline. The most commonly reported themes were Self-Consciousness, mentioned by 13 of 16 (81.3%) patients, Physical Symptoms, mentioned by 12 of 16 (75%), and then Fear of Disease Progression, by 11 of 16 (68.8%). Frequently mentioned physical signs/symptoms included erythema, itch, dyspigmentation, scar and alopecia. The physical signs/symptoms were categorised as activity signs/symptoms, damage signs and other. For activity signs, erythema was mentioned most frequently (5 of 16), then scale (2 of 16). For activity symptoms, itch was mentioned most frequently (6 of 16), then pain (5 of 16). For damage signs, dyspigmentation was mentioned most frequently (4 of 16), followed by scarring (3 of 16). Patients less than 60 years old were more likely to report emotional symptoms than older patients (p<0.05), but there was no significant variation in frequency of reported themes between race, sex or subtype of CLE.ConclusionsThese patient experiences and resultant themes elucidated by this study are worth noting in future standardised estimations of the quality of life of patients with CLE. Additionally, the concerns shown by these interviews are important topics for providers to discuss when evaluating patient disease progression.

2796 selected patients who tested to five AG, including LG and DG, had positive reactions to at least one glucoside. 2 In our study, 1Á5% of consecutively tested patients were sensitized to DG and/or LG.Concomitant positive reactions between DG and LG were found in 37% of patients. This may be due to cross-sensitivity due to structural similarities, or concomitant sensitization as they are often present in the same products. A recent study suggested that both surfactants need to be tested to optimize detection of ACD. 4 We agree that the rate of concomitant reactions is not high enough to test only one screening glucoside in the baseline series. Other AG, such as coco, arachidyl or cetearyl glucoside, should be tested separately if ACD is suspected.Most patients were female, which could reflect their higher use of cosmetics. Most patients were atopic. In patients with atopic dermatitis, an impaired skin barrier may enhance penetration of allergens, or conversely may lead to overinterpretation of some irritant reactions, and these certainly appear to be irritant allergens at standard patch-test concentrations. 5 'Doubtful' reactions should be repeat tested, or the patient should undergo a repeat open-application test, to verify whether they represent true ACD.The ESCD recommended the addition of DG and LG to its baseline series in January 2019Á 6 Both have been recommended for inclusion in the updated BSCA facial series. 7 In this audit, each of DG and LG, when tested in an extended baseline series, had rates of positive reactions greater than 0Á5% in consecutive patients. We suggest that these allergens be included in the BSCA baseline series.