Discoid lupus erythematosus responsive to sulphasalazine

SIR, Standard therapy for discoid lupus erythematosus (DLE) consists of potent topical steroids, with the attendant risk of steroid dermopathy. We report a patient who responded to sulphasalazine on two occasions with relapse on withdrawal of this systemic therapy. A 57-year-old woman was diagnosed as having DLE 18 years previously. The facial eruption, characterized by red, scaly plaques that were associated with scarring, could only be controlled for 12 years by the daily application of a potent steroid, occasional intralesional steroids and a sun screen. There was thinning of the skin and telangectasia. A presumptive diagnosis of ulcerative colitis was made 6 years ago when she was abroad and she was treated with sulphasalazine 500 mg four times a day. Within 2 months she noted an improvement of her facial rash and was able to reduce the frequency of application of the topical steroid to twice a week. After 18 months, in the absence of proven colitis, her sulphasalazine was stopped, without a relapse of her bowel symptoms. However, there was a marked deterioration of her DLE, resulting in increased usage of topical steroid after 3 months. Following 2 years of poor control with topical therapy, the patient was recommenced on sulphasalazine 500 mg twice a day, with some improvement. Complete control was achieved after a further year when the dose was increased to 500 mg four times a day. The patient has remained on this dose of sulphasalazine for the past year, requiring only very occasional topical steroid therapy and has suffered no side-effects.